HomeMy WebLinkAboutKongoletos ,o��SOFFO(,�-
ELIZABETH A.NEVILLE ���_'
`19;\
'y ; Town Hall, 53095 Main Road
TOWN CLERK o P.O. Box 1179
REGISTRAR OF VITAL STATISTICS i Southold, New York 11971
MARRIAGE OFFICER 1i � Fax Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER � �Ql I *a0,ii Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER ��' southoldtown.northfork.net
OFFICE OF TTHSEpTOWN CLERK
SOUTHOLD WAS WATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2920 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : NANCY KONGOLETOS
Address 1 : 36 ANNA COURT
City St Zip WADING RIVER NY 11792
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 #R10-02-0160
Name Of Owner KONGOLETOS, NANCY
Mailing Address 1 36 ANNA COURT
City St Zip WADING RIVER NY 11792
Property Address 1 57958 MAIN ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 66.00 block 2 lot 2.004
Cross Street MAIN ROAD
Building Permit Number Cross Reference:
Issue Date: 10/30/02 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
z«
&,iu ee--, 1)9026
ELIZABETH A. NEVILLE til �
� G# Town Hall, 53095 Main Road
TOWN CLERK o - ; P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS e. �*. 0 Fax(631) 765-6145
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER �,_* i•'060
FREEDOM
Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER���,���� southoldtown.northfork.net
t 1�.v......_i___--.ii,i it
1 r1i OFFICE OF THE TOWN CLERK
i si t OCT 8 9 2002 !..J TOWN OF SOUTHOLD
0: TOWN coutholdtTo i Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: 10/11/2002
Transmitted herewith is a copy of application No. 3039 for a Cesspool/Septic Tank Construction Permit
submitted by: Nancy A. Kongoletos
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: .rte-f-.�
7,,,.... ..-,.1g7,4,
Signature
/07--A2__
Dated
OFFICE OF THE TOWN CLERK ��,,•
,,�"„,,,,,,
FT.i7ABETWTONOFSOUA. ,TOWNCLERK ��FFnck�oGy Application No.3i� 9
P.O.BOX 1179
Construction
SOUTHOLD,NEW YORK 11971
v • ' Alteration
• cn �� �.
Telephone ` $10.00 - Residential !X
(G3-l:) 765-1800 _O��®l $‘Oi� ' `'" �•
� $25.00 -Non-Residential
TOWN OF SOUTHOLD •
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
•
APPLICATION •
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. .
Fee .$
DATE /o 7/1 /02_
APPLICANT NAME: /V jiiY • etAdy s •
l
APPLICANT ADDRESS: /u flPL �f
bOadd A l 4by
SEPTIC
CESSPOOL
DESCRIPTION OF PROPOSED CO TRUCTION OR ALTERATION
(.71/577. C.'
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION R ALTS ATION:
OWNER OF PROPERTY: NamaL ,t i
OWNER MAILING ADDRESS: r
1W � - i MY [ 7d12-
OWNER PROPERTY ADDRESS: . 72. /1-4 Q.-/,
)1.)77-100)1 / 9 71
TELEPHONE NUMBER OF CONTACT PERSON: 9ZQ'- 5j47
TAX MAP NO. : Section (0(.0 Block 2- Lot 2 /7
CROSS STREET: /10._(//) -at
BUILDING PERMIT NUMBER CROSS REFERENCE:
17?-ibt „ f # •
ig ature of A. olicant
RECEIVED BY:4110
T. Clerk's Office
DATE: // /jIV
. _r
• 'SURVEY OF LOT 4
MINOR SUED I V I S I ON OF FOR N. GHARLES DELUGA _, - „,
SITUATE: SOUTHOLD /
1014l: SOUTHOLD 2 r-';
SUFFOLK COUNTY, NY )0L' `
SURVEYED 0�-08-02, `'P '
PROPOSED HOUSE 08-14-02 ,,A
SUFFOLK COUNTY TAX # �q-
1000-66-2-2.4 - ' 7 - - ' — ......
- - c �'
CERTIFIED T0: v\ ; /
A 4AAd% e 7
.& �r �`,` LOT N
Nancy Kongoletos
First American Tide Insurance s VACANT e
Company of New York \ii,\?)%
;o`
�,, ';`- S
` W.
LOT
' S7?a49�,��` 2
VACANT
At* ..oriNG -- IT ``�
9, - ppRogo '`,,
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES 5S52i 'mow - ---- `
PERMIT FOR APPROVAL OF CONSTRUCTION FOR A444 •
_ SINGLE FAMILY RESIDENCE ONLY �-4St'Sv_---- I
V-2,{} ;;—
N
DATE cI-R-a�H.S. REF. N0. /D - do?A;;;//6 o
APPROVEDoho rrnn
60' fn x
FOR MAXIMUM OF 1.# BtOMS I �� y n'y
EXPIRES THREE YEARS FROM DATE OF APPROVAL • t`3 I \ ` `°
�PP
c ` 1t O Y 7A I
LOT I
n
3 I LOT z 30
I 4 I DA
PROP -K rn
I SEPTIC\ I .\ r A
Imo( /J� I ` Z-(
-ay
I `� A11
T
0
I I 905 I 8 T
.,
POWS? PROPOSED in I /--"""
r.
I \• D DECKS WELLING r0 •I
- 50' i 66'
1,8_ I
� 25'� I
� I \ I -CDA I -
0 O
\ so I
/ 0 r D C)
w/� `! •
♦♦♦ / m '\ 40' I 2001
W ♦♦' °01 N I CA rn
Test Hole 8 ,�° ♦� N 1 Zo �z
from Filed Mop `• �♦� <%�,�� I oa
♦ d \ - 00 Oz
To,son �\ Toq,' e♦♦� 4 .
gRi ga p
1' �� s� GAO
- �`. ♦oReGyRya I 10 0 A
,' \ pNcF,G r w"11
`,c)O ♦♦� I z A A
Izm
♦ A
B< ♦♦ Dr
y
\ � . AO
5and ,` • \'1� D
r
-FS6-o ,y'cs : p --
' /ib rT, 41 .ATF ,
. \(34,/,.... , ,- -. . „..,
,,, . -
‹ _;-.:-.2., . u - -
/Or C, �w�
���Q� G. EH b�` fifi
NOTES:
taco .,1 � .
Vnboorv,Letl alteration Or -oe on to a 9vrvey
AREA = 78,-161 SF OR 1051 ACRES * mop beo m oa licensed la d surveyors seal Is
_, violatbn F section 1209,sutreN,slon�,of tM
-ii,
l .� Nen Tork Stale EwLatian Lar"
-
ELEVATIONS SHOWN REFERENCE NOVO '21 � �� 11 `t !�' 1 + �only aapi==From the original of his survey
ked With an original of the land surveyor's
%
=.._- Q� 9eompea seal mall x�onaeerea t°be vaua tNe
A. # caplea
th
THE DOCK REFERENCED ON THIS SURVEY IS 50202 ,` J� �� 'Certifications
Ley`„as`P eP�'d le oma��`w„`this
OF ONE BOARD 8 INCHES WIDE FO C V� isting Lode of Practice For Land Surveys adoptee
by the Nen York state Association of Professional
AND SUPPORTED APPROXIMATELY I FOOT ABOVE '' me�rveyora 5oe`ertif"atb 0 sMll r°°nly
to the person For Whom the survey is prapored,
THE WATER BY WOODEN POSTS a tl on his beMlF to the title company g°vemmen-
the assignees ees of the tiding l°n Ilstaa hereon.and
to the of the lending Institution Lertlfica-
toms are rot transferable!°additl°ml trlstitutions
JOHN C. E a LE'.'.S LAND SURVE ' O='`
6 EAST MAIN STREET N.Y.S.LIC.NO.50202
GRAPHIC, ALE 1".60' RIVERHEAD,N.Y. 11901 REF.\\Hp server\d\PROS\01-116H.pro
Mil
369-8288 Fax 369-8287
• 009/2000 2,9{,9lf+f WO serv0PWFROrbI-llbearo