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JUDITH T.TERRY �I_� ?1 Town Hall, 53095 Main Road
TOWN CLERK ; y P.O. Box 1179
4 t Southold,New York 11971
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REGISTRAR OF VITAL STATISTICS %•14e1
1O4,01 Fax Fax(516) 765-1823
49/MARRIAGE OFFICR
RECORDS MANAGEMENT OFFICER : � `1►��11�� Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER ,
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1785 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : INLAND HOMES INC.
Address 1 : P. O. BOX 117
City St Zip MATTITUCK NY 11952
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.
Name Of Owner INLAND HOMES INC.
Mailing Address 1 P. O. BOX 117
City St Zip MATTITUCK NY 11952
Property Address 1 HENRYS LANE
City St Zip PECONIC NY 11958
Tax Map No. section 74.00 block 2 lot 32.000
Cross Street ROUTE 48
Building Permit Number Cross Reference:
Issue Date: 12/22/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY v1.: y` Town Hall, 53095 Main Road
TOWN CLERK % y =P .O. Box 1179
� ,% Southold, New York 11971
REGISTRAR OF VITAL STATISTICS ,1
MARRIAGE OFFICER �=yifr �� �It' Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER 49l 'O . Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER ,••40�,,
E C EDT1
OFFICE OF THE TOWN CLER
TOWN OF SOUTHOLD ap
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B�DC.DEPT.
TO: Southold Town Building Department N_9P�
yt
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: December 18, 1997
Transmitted herewith is a copy of application No. 1859 for a Cesspool/
Septic Tank Construction Permit submitted by:
Inland Homes .
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.
Thank you.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE6.7
DISAPPROVE
Comments:
ignatr
Dated
OFFICE OF THE TOWN CLERK 5\FF0(,'� cy
Town of Southold O�� 0 .1 Application No. Ism I
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road $10.00 Residential ✓
P. O. Box 1179 cn $25.00 - Non-Residential
Southold, New York 11971 -ft' * *go'
Telephone
( 51 6) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE 12/18/97
OWNER NAME: Inland Homes
OWNER MAILING ADDRESS: PO Box 117
Mattituck,N.Y. ,'1'1952
•
OWNER PROPERTY ADDRESS : Henrys lane
Peo nic, N.Y. _-- -- — —OWNER TELEPHONE NUMBER : 298_9696 pi"
TAX MAP NO. : Section 7k Block 02 Lot 32
CROSS STREET : Rt. #48
TYPE OF SYSTEM: Septic Tank -New Existing
Cesspool New Existing ___
Residential Non-Residential
LOCATION MAP: Must be attached hereto before permit may be issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road. )
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RECEIVED BY : ?Pvt.-
Town Clerk'
-'"TownClerk's Office
DATE : 1d'2`1C:3\GIa -- - - -
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SURVEY OF
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, , o LOT 31
"PECONIC HOMES"
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I/1r '.4*•'' -'‘).-- 14,7+ FILED OCT. 1964 FILE NO. 4181
AT PECONIC ...
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TOWN OF SOUTHOLD
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......- -- \ ,. SUFFOLK COUNTY, N . Y.
, , \ s, - - • „,, - - c. -A., 1000-74-02-32
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OCTOBER 15. 1997
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, ' : • 3'.-I.C•1 \ I an familiar with the STANDARDS FOR APPROVAL
\e,/ .,,.. .',.- '''., 6..v.- AND CONSTRUCTION OF SIAOSLOVFACE SEIVAIgt t.
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„. --.. DISPOSAL snraa roR .SALE FAMILY RESIDENCES ---.
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• and wal abide bi the {:oodflions sal forth therein and oh the ,
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%! A. A The locations of wets and-cesspools
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