HomeMy WebLinkAboutNikolakakas • ELIZABETH A.NEVILLE,MMC Sao �/y Town Hall,53095 Main Road
TOWN CLERK ® � P.O.Box 1179
CA Z Southold,New York 11971
REGISTRAR OF VITAL STATISTICS ® Fax(631)765-6145
MARRIAGE OFFICER �� ®!' Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
" TOWN OF SOUTHOLD
v D
TO: Southold Town Building Department
NOV 2 1 2016
FROM: Sabrina Born, Southold Town Clerk's Office
BUILDINGDEPT.
DATED: November 21, 2016 TOWN OF SOUTHOLD
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4447 for a Cesspool/Septic Tank Construction
Permit submitted by:
Joseph Fischetti for Stelios & Penelope Nikolakakos
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.
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments: Final approval required from the Suffolk County Health Department
RECEIVED
Signat e
DEC 2 3 2016 3
S,m0old Town Clerk Dated
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 4447 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : JOSEPH FISCHETTI
Address 1: 1725 HOBART RD
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. FINAL
APPROVAL REQUIRED FROM THE SUFFOLK COUNTY HEALTH DEPARTMENT. REF# 810-
16-0078
Name Of Owner STELIOS & PENELOPE NIKOLAKAKOS
------------------------------
Mailing Address 1 105 THIRD ST
------------------------------
----------- ------------------
city
-----------------------------------------------------------
City St zip GARDEN CITY NY 11530
-------------------- -- ----------
Property Address 1 STELIOS & PENELOPE NIKOLAKAKOS
------------------------------
20795 SOUNDVIEW AVE
------------------------------
City St zip SOUTHOLD NY 11971
-------------------- -- ----------
Tax Map No. section 51.00 block 4 lot 13.000
Cross Street WILD BERRY LANE
------------------------------
Building Permit Number Cross Reference:
Issue Date: 12/28/16 Eliz A. Neville
-------- Southold Town Clerk
(TOWN SEAL)
F 1
ELIZABETH A. NEVILLE,MMC Town Hall,53095 Main Road
TOWN CLERK a P.O. Box 1179
C4 at Southold,New York 11971
REGISTRAR OF VITAI STATISTICS Fax(631)765-614.5
MARRIAGE OFFICER Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Sabrina Born, Southold Town Clerk's Office
DATED: November 21, 2016
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4447 for a Cesspool/Septic Tank Construction
Permit submitted by:
Joseph Fischetti for Stelios & Penelope Nikolakakos
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.
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments: Final approval required from the Suffolk County Health Department
Signature
Dated
0
ELIZABETH A. NEVILLIa,' G�� Town Hall, 63095 Main Roa,
TOWN CLERKCP
P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS y.
MARRIAGE OFFICER ` ` Fax (631) 765-6146
RECORDS MANAGEMENT OFFICER ��f® �O� Telephone (631) 766-1800
FREEDOM OF INFORMATION OFFICER southoldtown,northfork.net
OFFICE OF TTIE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @$10 Q( or Non-Residential @$2S Application No. '`�
Permit No.
Applicant Name
Applicant Mailing Address 0kkhv%'
Septic Tank. LZor Cesspool
Brief Description of Proposed Construction or Alteration ly e""W 5 '- leg-,I
Location of Proposed Construction/Alteration: ��'_ D taka os
Owner of Property:_ S J�0, ,�@ le '/�� 1,
Owner Mailing Address: 0 ..a15 z'j Ad,y 14—ty
d
Owner Property Address: P /J ' / 4-k 0
Name and phone number of contact person
Tax Map No: S 'on Block Lot d
Cross Street 1n
NOTE. LOCATION MAP MUST\ k\SUBAUTTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURY TiEALTH DEPARTMENT APPROVAL
Sign a3 e >fApplicant Bate
Received.by: °"
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