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ELIZABETH A.NEVILLE �` Town Hall 53095 Main Road
TOWN CLERK ® } ; ? a P.O. Box 1179
REGISTRAR OF VITAL STATISTICS '^<;,c5;., � Southold, New York 11971
MARRIAGE OFFICER `�®�o ` E44?
Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER �*�, ®I�� Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER `iso *1.
OFFICE OF THE TOWN CLERK
SOUTHOLD VARTWATTEIRTIMEOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2693 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : CUSTOM DESIGN HOMES OF LI INC
Address 1 : C/O C MESIANO INC
City St Zip EAST MORICHES NY 11940
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. REF #R10-01-0182
Name Of Owner PAPALOULSOS, DIKAS
Mailing Address 1 30-20 34TH STREET
City St Zip ASTORIA NY 11103
Property Address 1 4700 MAIN ROAC
City St Zip GREENPORT NY 11944
Tax Map No. section 35.00 block 5 lot 5.001
Cross Street MAPLE LANE
Building Permit Number Cross Reference:
Issue Date: 11/19/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
SVFOUr 02 6°9 3
ELIZABETH A.NEVILLE ti �� ��� '
ry '84 Town Hall, 53095 Main Road
TOWN CLERK ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ® `Y Southold, New York 11971
ti
MARRIAGE OFFICER : s� n ' �'�1) Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER "t_...72049 �®'• Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER - '' so
OFFICE OF THE TOWN CLERK Pr FIVE
TOWN OF SOUTHOLD
NOV 8 2001
TO: Southold Town Building Department
()VIM Clerk
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: November 5, 2001
Transmitted herewith is a copy of application No. 2786 for a Cesspool/Septic Tank
CONSTRUCTION/ALTERATION Permit submitted by:
Custom Designer Homes of L I Inc. (C. Mesiano) for Dikea Papaloulsos
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: Maintain required setbacks from adjacent wells,buildings,property lines and water
Bodies. EXCAVATION INSPECTION REQUIRED.
Signature 7
7A1
Dated i
OFFICE OF THE TOWN CLERK ,,�'°�SAEPair Application No. 7
TOWN OF SOUTHOLD
EL[ZAHETH A.NEVILLE,TOWN CLERK '
P.O.BOX 1179 •c Construction
SOLTHOLD,NEW YOAK119/1 FM Alteration
Telephone $10.00 -Residential
(516) 765-1601 ,' r $25.00 -Non-Residential
TOWN OF SOUTHOLD
•
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE 415/0(
APPLICANT NAME: (.I Aal n
APPLICANT ADDRESS: c/o a. , .
f tutee , n'y 119 Oo
SEPTIC (X CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
4 6,(- . ,Ly /y da. .//€...f,
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: 2cke Ra-la-100/56•5
OWNER MAILING ADDRESS: , 5 3O-Q0 °3LI
111 9c
sOY
OWNER'PROPERTY ADDRESS: 44pj /nQen /2.d. gii.e...yar
TELEPHONE NUMBER OF CONTACT PERSON: $18-84e1
TAX MAP NO.: Section 3.5 Block 5 Lot 5.1
CROSS STREET':, m nil, La.,,e W Corner n7a rV11aa/�)
BUILDING PERMIT-NUMBER CROSS REFERENCE:
i�l ,1 4. .
Signature of A.
RECEIVED BY:
Town Clerk's Office
DATE:
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