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ELIZABETH A. NEVILLE d��� '�.11 Town Hall, 53095 Main Road
TOWN CLERK ; H P.O. Box 1179
REGISTRAR OF VITAL STATISTICS �e Southold, New York 11971
MARRIAGE OFFICER : sfi �1� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER �®1°i� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER i�
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OFFICE OF THE TOWN CLERK
SOUTHOLD InkinTEMPisTcrgtrjataficiSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2674 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : PECONIC CESSPOOL
Address 1 : PO BOX 972
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
ADDITION TO EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES.
EXCAVATION INSPECTION REQUIRED.
Name Of Owner FOKAS, ANDREAS
Mailing Address 1 8765 MAIN ROAD
City St Zip EAST MARION NY 11939
Property Address 1 8765 MAIN ROAD
City St Zip EAST MARION NY 11939
Tax Map No. section 31 .00 block 3 lot 15.000
Cross Street
Building Permit Number Cross Reference:
Issue Date: 10/18/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE � x Town Hall, 53095 Main Road
TOWN CLERK ; .l � ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ;< . ,,V 't1 Southold, New York 11971
MARRIAGE OFFICER '�� Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER �;�Q/4 �'2 ii Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER `is' �0
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: October 10, 2001
Transmitted herewith is a copy of application No. 2766 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Peconic Cesspool for Andreas Fokas
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:
APPROVE1V
DISAPPROVE
Comments: Maintain required setbacks from adjacent wells,buildings,property lines and water
Bodies. EXCAVATION INSPECTION REQUIRED.
Signature
IL c 2 c/
Dated
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OFFICE OF THE TOWN CLERKCOULb ' c2T7
TOWN OF SOUTHOLD �� �1�'QG Application No. - W
ELIZABETH A.NEVILLE,TOWN CLERK Construction
P.O.BOX 1179
SOUTHOLD,NHW YORK 11971 ` � ;
r71 ) Alteration
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Telephone ` �Q� '� $10.00 - Residential X
(631) 765-1800 _ . O.j e
� ��' $25.00 - Non-Residential
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION •
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
OCTOBER 5
DATE Vni1=tX 2001
APPLICANT NAME: . PECONIC CESSPOOL
APPLICANT ADDRESS: P. 0. BOX 972
MATTITUCK, NEW YORK 11952"
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: ANDRFAS FOKAS
OWNER MAILING ADDRESS: 8765 MAIN ROAD
EAST MARION, NEW YORK 11939
OWNER PROPERTY ADDRESS: 8765 MAIN ROAD
EAST MARION, NEW YORK
TELEPHONE NUMBER OF CONTACT PERSON: Richard Magill 298-9658
TAX MAP NO. : Section 3 / Block 3 Lot 15
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
•
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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Andreas Fokas
- 8765 Main Road
East Marion, New York
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