HomeMy WebLinkAboutPerivolaris II•0"cjiFF0/4-4,® `
ELIZABETH A.NEVILLE ,,ig� �* 1 Town Hall, 53095 Main Road
TOWN CLERK o P.O. Box 1179
ti a Southold New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER ,y �� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER "'/®1 �� iii Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER rrr' southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2934 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 PERIVOLARIS, MIKE & KATHY
Mailing Address 1 1486 SWEETMAN AVENUE
City St Zip ELMONT NY 11003
Property Address 1 1155 LOVE LANE
City St Zip MATTITUCK NY 11952
Tax Map No. section 140.00 block 1 lot 20.000
Cross Street
Building Permit Number Cross Reference:
Issue Date: 12/17/02 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE to.1.# G1 Town Hall, 53095 Main Road
TOWN CLERK o - P.O. Box 1179
REGISTRAR OF VITAL STATISTICS i Southold, New York 11971
MARRIAGE OFFICER
‘`.14 11$4���, Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER � ' 1 **O6'i� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ��' southoldtown.northfork.net
'%... .•0
`,;OFFICE OF THE TOWNCLERK
TOWN OF SOUTHOLD
•
®cC 2 B 202 5._
TO: \ Southold Tpwn)Bu_ilding Department
FROM: I;inda J. Cooper, Southold Town Clerk's Office
DATED: October 25, 2002
Transmitted herewith is a copy of application No. 3050 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Peconic Cesspool for Perirolaris
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
/7/3/2....
Dated
A1- 'ems
OFFICE OF THE TOWN CLERK itsPOVEILke
TOWN OF SOUTHOLD ®G Application No.30.5O
ELIZABETH A.NEVILLE,TOWN CLERK
P.O.BOX i 179 ' `�•�
Construction
SOUfHOID,NEW YORK 11971 i
;Ill3 IAlteration
Telephone � �Q��'�1 $10.00 —Residential J
(G31) 765-18001 $25.00 - Non-Residential
•TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
RECEIVE!)
• APPLICATION OCT 2 5 2002
for
CONSTRUCTION or ALTERATION PERMIT Southold Town Clerk
SEPTIC TANK or CESSPOOL
Permit No.
Fee •$
DATE ( 0. 1� /® X-
APPLICANT NAME: PECONIC CESSPOOL
APPLICANT ADDRESS: P. 0. BOX 972
MATTITUCK, NEW YORK 11952 •
SEPTIC CESSPOOL
DESCRIPTION OFROPOSED CONSTRUCTION OR ALTERATION
4.1).7-21.7t
C S
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION. OF PROPOSED CONSTRUCTION OR ALTERATION:
. OWNER OF PROPERTY: Iffiiesi. fr, 4
OWNER MAILING ADDRESS: //S!j Lave ,e
OWNER PROPERTY ADDRESS: Li (6, �we.:d-m Ali -Poe_
EI►Mu NSP 'loos
TELEPHONE NUMBER OF CONTACT PERSON: —q-4
TAX MAP NO. : Section ,/ Block ® / Lot
CROSS STREET:
BUILDING PERMIT NUMBER CROS!::; REFERENCE:
/:fAVek
Signature of '/aplicant
•
RECEIVED' BY:
Town Clerk's Office —
DATE:
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-- Michael & Kathy Perivolaris
, 1155 Love Lane, Mattituck
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