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ELIZABETH A. NEVILLE ®Gy : Town Hall, 53095 Main Road
TOWN CLERK \ y 2 P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ` Southold, New York 11971
MARRIAGE OFFICER .` y �1�, Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER �_� •gb, to Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER - 0
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2533 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : MORRIS CESSPOOL
Address 1 : 2760 YENNECOTT DRIVE
City St Zip SOUTHOLD NY 11971
Descripton of Proposed Construction or Alteration
ADDITION OF OVERFLOW TO EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES.
EXCAVATION INSPECTION REQUIRED.
Name Of Owner GEORGE KORTSOLAKIS
Mailing Address 1 7901 RIDGE BLVD
City St Zip BROOKLYN NY 11209
Property Address 1 8875 MAIN ROAD
City St Zip EAST MARION NY 11939
Tax Map No. section 31 .00 block 3 lot 12.000
Cross Street OLD ORCHARD ROAD
Building Permit Number Cross Reference:
Issue Date: ' 3/27/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE t, A4: Town Hall, 53095 Main Road
TOWN CLERK y __ _ Y -- P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ` r ,��'___ 1 ,�'r_7 7"outhold, New York 11971
MARRIAGE,OFFICER �� �f+ .4*eel �' t6 , Fax (631) 765-6145
RECORDS FREEDOM OMANAGEMENT ORMA ION OFF CER � �� „ `aO��i n �,
( �� � �� 2001 . ;Telephone (631) 765-1800
1
61
OFFICE OF TIDE-TOWN-CLERK-=2-.
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: March 14, 2001
Transmitted herewith is a copy of application No. 2621 for a Cesspool/Septic Tank Construction
Permit submitted by:
Morris Cesspool for Kortsolakis
Please review the application and location map and advise if the project has received Suffolk County
Health Department approval and if this office may issue the permit.
Please complete the form below and return it to me.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments:
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Dated
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OFFICE OFT=TOWN CLERIC , O�`1 DLK QQ G ,
TOWNOFBOUTHOLD �� S Application No.
ELIZABETH A.NEVILLE,TOWN CLERK ��
P.O.BOX 1179 Construction
SOUTHOLD,NEW YORK 11971P •
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EP Alteration
Telephone % �Qre's, $10.00 - Residential
(63t) 765-1800 �,, " $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
F for
1Zt
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE /)1-R / L7 o (
APPLICANT NAME: . 4/,02 41i �/1i13-egg
APPLICANT ADDRESS: ,/� 9 �c,44 rr /0
SEPTIC CESSPOOL
DESCRIPTION OF ROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
• OWNER OF PROPERTY: 6' 1z p/ kORTIO/�-,�/�
OWNER MAILING ADDRESS: 7f o� K74--to c.g2
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OWNER PROPERTY ADDRESS: ?/7,5^ /n ,'tii �eY
/2//s-Y ,7M- 11/ Ivy
TELEPHONE NUMBER OF CONTACT PERSON: 7iY -
TAX
MAP NO. : Section 8 / Block 5 Lot / ��--
CROSS STREET: c,/I aeckl,e(P
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature o Applicant
RECEIVED BY:
Town le k's Office
SAT E: J , 12///:7.
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