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Liuanos, Bill
SQlTHCLD VfA�STEVI�ITER DI SPC6AL PERM T OCnSTRUCTI CN CR ALTERP�TI CN PEI�M T SEPTI C TAI�K or CESSPOCL Per rri t� No. 4395 R F�si dent i al X Non-F�si dent i al Fee $ 10. 00 Sept i c X Cesspool PEF�IA T I SSI�D TQ IV�rre : q-IARL.ES TFIQII�S � Addr ess 1: P O BC�C 877 Ci t y St Zi p JAIVESF'CRT NY 11947 D�scr i pt on of Pr oposed Const r uct i on or AI t er at i on SAN TARY SYSTEM FCR SI NC�E FAM LY UJ'�LLI NG APPROdED AS SI�M TTED Af�D AS APPRO�ED BY TI-E SI�FCLK OQ�fTY DEPARTNENT ' CF IfALTH SERVI CES. FI NAL. APPF�/AL REC� RED FRCM TI-E SI�FCLK CC�lT°Y F-EAL.TH DEPARTNENT. REF #R10-16-0040. Narre Cf C�ner BI LL LI 11�N06 ------------------------------ N�i I i ng Addr ess 1 54 V'�I C�-ITS M LL FtO�D ------------------------------ ------------------------------ � Ci t y St Zi p • AF�Q�K � NY 10504 -------------------- -- ---------- Pr oper t y Addr ess 1 1795 SUVM T DRI VE ------------------------------ ------------------------------ ' a t y St Zi p N1�TTI TUC�( NY 11952 -------------------- -- ---------- Tax N�p No. sect i on 106. 00 bl ock 1 I ot 30. 200 ; ------ --- ------ Q�oss St r eet M W AN FtO�D ------------------------------ Bui I di ng Per rri t Narrber (7 oss F�f er ence: -------------------------------=-- I ssue �t e: 8/04/ 16 � i zabet h A, f�vi I I e -------- Southol d Town C! erk (TC�1 SEAL) ���gyFFO`,r�oG - : ELIZABETH A.NEVILLE,MMC �y. y Town Hall,53095 Main Road TOWN CLERK a � P.O.Box 1179 y Z Southold,New York 11971 REGISTRAR OF VITAL STATISTICS ��� � yC Fax(631)765-6145 MARRIAGE OFFTCER y �' RECORDS MANAGEMENT OFFTCER �0,(,� �`�� Telephone(631)765-1800 www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER ' � OFFICE OF TH� TOWN CLE1�K TOWN OF SOUTHOLD -�����,���`� i -` �. � � �-- �� . TO: Southold Town Building Department � FROM: Carol Hydell, Southold Town Clerk's Office � � ,1UN 1 4 2016 DATED: June 14, 2016 ���,������° ' ���� ���������� RE: Cesspool Construction Application Transmitted herewith is a copy of application No. 4395 for a CesspooUSeptic Tank Construction Pernut submitted by: Charles Thomas for Bill Livanos Please review the application and location map and advise if this office may issue the permit. Please complete the form below and return it to me. Thank you. � � � � � � � * � � �x � I have reviewed the application and location map of the project cited ab'ove and make the following _ / � � 4 - � recommendations: � �` , . � V � �� APPROVE _ � � G�,,S, z/ z o/G.,�� '�zG fG�"" DISAPPROVE Comments: Final approval required from the Suffolk Countp Health Department f � � : Signature _ 3� 2��� . D � .. ������� ` �'� ' ��' Town Hall,53095 Main Road ELIZABETH A.1�VILI.E ,�,,�`►`, �� ' ,���C�� ,� � P.O.Box 1179 � � Southold,New York 11971 REGISTRAR OF VITAL STATISTICS �� Fax(631) 765-6145 MARRIAGE OFFICER ' � �F � ' � RECORDS MANAGEMENT OFFICER ��. �•��� •.�.�,��^ Telephona(631) 765-1800 FREEDOM OF INF(7RM�TION OFFICEft z southoldtown.northfork.net O�FICE �g' TI�E TO�T CLE�3,� � TOWN OF SOUTHOLD �OUTI30II,,I)Wr�S��6'r�"�"ER DIS�tIICT A�'I'�.:;;���`�'�410I COI�tST12UCTI011�T or AL.TERATYOI�PERMI�' � CESSPfJOL or�EP7CIC TANI� Residential @ $1�l� or Non-Residential @$25 Application No.�J Permit No,.. Applicant Naxne � _ � , ���-�.`"`�.-"�.,'�`� -_ , , Applicant Mailin.g Address �D �?� ..�(� ���. _ �E����� Septic Tank t/or C��pc�ol,_„� Brief Description of Proposed Construction or Alteration .�'� : t�'"��'� , � � _, Location of Proposed Construction/Altera�ion: Owner of Property: �1(.,�C�--_ �-�tJ �D S Owner Maaling Address: - . 3..�,.. ° . _ - . � � � ��� P , Owner Propezly Address: ���� �����'�'"` �'�`'� U °-`�' � . '.. �;��— ' ; ' s Name and phane number of contact person��"���.��� ��-��'���;� T�IVdap No: Section f o Block � Lot �p-;� Cross Street NC�'TE: LOCATION MAP 1l�IUST �E SU�TVIITTED WIT� APPLICATION. l�i�V C(Jl�S'I'�.tUC�ION�QUII�S S1U12VE'i'�� � � " TH I)EPARTI�EN'T APPROVl�i, �- ignature of Applicant Date � Received b : �.'��` Y - �,� ��'�'� r�� ta �. y�h � yp`� . � 10 4� � �`� �� � � �� �`� 9a ad 1 ���;�'� � , �' ���� `�yr� ttvo� 1._.��t�.. -�ai � ��'.�� � �'".�, �,�„�,,,'�t-t�. 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