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ELIZABETH A.NEVILLE �_w G* �• Town Hall, 53095 Main Road
TOWN CLERK % ti dP.O. Box 1179
Southold,
REGISTRAR OF VITAL STATISTICS �° t
New York 11971
MARRIAGE OFFICER ` �i �`V. Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER ?_�®� �V®,i" Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ,s" 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. 2936 R Residential X Non-Residential
Fee $ 10.00 Septic x Cesspool
PERMIT ISSUED TO:
Name : RAYMOND AKSCIN
Address 1: 1800 CEDAR BEACH ROAD
City St Zip SOUTHOLD NY 11971
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 #R10-02-0172
Name Of Owner AKSCIN, RAYMOND
Mailing Address 1 1800 CEDAR BEACH ROAD
City St Zip SOUTHOLD NY 11971
Property Address 1 1800 CEDAR BEACH ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 88.00 block 2 lot 17.004
Cross Street MIDLAND PARK WAY
Building Permit Number cross Reference:
Issue Date: 12/17/02 Elizabeth A. Neville
Southold Town clerk
(TOWN SEAL)
s"
.i .. ..... 1,1 ofFour --.. 0793
ELIZABETH A. NEVILLE I�_� O
Gy1 Town Hall, 53095 Main Road
TOWN CLERK o - % P.O. Box 1179
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REGISTRAR OF VITAL STATISTICS ,t Southold, New York 11971
MARRIAGE OFFICER :`,�i� o����� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER o! $s ii Telephone (631) 765-1800
FREEDOM OF INFORMATION N.OFFICER - ...� southoldtown.northfork.net
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
LTOG"-- . ' ' Southol'd_To n Building Department
fes., _ _ --
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: October 30, 2002
Transmitted herewith is a copy of application No. 3055 for a Cesspool/Septic Tank Construction
Permit submitted by:
Raymond Jay Akscin
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: �r-e ',"� y � / P77714.,e,,,,, -
1
4
Signature
Dated
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OFFICE OF THE TOWN CLERK �"
TOWN OF SOUTHOCOQIi Application No. 0<
ELIZABETH A.NEVILLE,TOWNCLERK
P.O.BOX 1179 Construction
SOUTHOLD,NEW YORK 11971 =v • T
Alteration
Telephone ,j� bQ�i: • $10.00 -Residential
(631) 765-1800 =��1 *,�'� $25.00 -Non-Residential
•
TOWN OF SOUTHOLD •
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE /0 -02_..
APPLICANT NAME: le0 ,y cz-4
APPLICANT ADDRESS: C' Gt°�
adv-//2A (// . /
SEPT IC fNCESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
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.
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTR TION OR ALTERAT7ION:
OWNER OF PROPERTY: Aq 4) �// ;1 /v
OWNER MAILING ADDRESS: goo pp, (0,
5)P 0%toil /1) /1 92(
OWNER PROPERTY ADDRESS: 9t9/-2C-
TELEPHONE
,0 C-
TELEPHONE NUMBER OF CONTACT PERSON: 6 — c 7
TAX MAP NO. : Section Block Lot 1
CROSS STREET: 4402/V/ k w,A C`i '/
BUILDING PERMIT NUMBER CROSS REFERENCE: /7/41/Vel elie_kft/A7
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Signatur ..f • p. icant
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RECEIVED BY: t vV\
own CA 's Office
DATE: IOI�O�O"L
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— - SURVEY OF PROPERTY , , ,
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, /ic,•4-ivr) Sti'.7FOL.K COMITY
TOWN OF SOUTHOLD ,.
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SUFFOLK COUNTY, NEW YORK ., Y
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