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JUDITH T.TERRY _� Gyt`� Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
0 r'nti Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER *4. y ,�1 Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER O.( , �►����� Fax
(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. 1638 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : INLAND HOMES
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
Mailing Address 1 P. O. BOX 117
City St Zip MATTITUCK NY 11952
Property Address 1 COREY CREEK LANE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 78.00 block 4 lot 9.000
Cross Street MAIN BAYVIEW ROAD
Building Permit Number Cross Reference:
Issue Date: 4/22/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
4OL 11
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i Town Hall, 53095 Main Road
• . P.O. Box 1179
.�.. o��1, y�l �� Southold, New York 11971
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JUDITH T.TERRY .�/ _ TELEPHONE
TOWN CLERK ,\,���� (516) 765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: April 3, 1997
Transmitted herewith is a copy of application No. 1707 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.
4-')c°1-c-`
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recomme ations:
APPROVE
DISAPPROVE
Comments:
RECEIVED
APR 2 s' 1997 Signature
Ae 7
Southold Town Crxt Dated
OFFICE OF THE TOWN CLERK ••�FFO(A.�'-
Town of Southold � CQG Application No. / '7 47
Judith T. Terry, Town Clerk .` y
Town Hall, 53095 Main Road ;4 $10.00 - Residential
P. 0. Box 1179 ul PR; $25.00 - Non-Residential
Southold, New York 11971 OO .$
Telephone : j ,
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
GG(� S 47-a L7(/6ry
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE 4/3/97
OWNER NAME: Inland Homes
OWNER MAILING ADDRESS:P° Box 117,Mattituck,NY,11952
OWNER PROPERTY ADDRESS:Corey Creek Lane,Southold
OWNER TELEPHONE NUMBER:
298-9696
TAX MAP NO. : Section 78 Block 04 Lot 9
CROSS STREET: Main Bayview Rd.
TYPE OF SYSTEM: Septic Tank New i# Existing
Cesspool New Existing
Residential MI 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.)
1
Signature • ••:p icant
RECEIVED BY: /11/
Town Clerk's fice
DATE: Li//5/
....-
SUR VL Y Ut- j
LOT 9
'we" °' 0 �eiir�y " OREY CREEK ESTATES"
O ,tee N ,�
FL® AUCs 15, 1987 MAP MO. 4923
f� �,« , o 70 \ 6rO' , AT BA YVIEW
0 ,, reg-' \ �;o'+
m TOWN OF SOUTHOLD
•• \\
SUFFOLK COUNTY, N. Y.
220.49' " t 14.9
/55 \ 1000 - 78 - 04 - 11
N. 8427'40' E r„
`l Scale: 1" = 40'
U) .' /$0 n eiii-,1 Mar. 4, 1997
y Z PPP (,wL, p9,� \ U'' �\ QLW
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o . 3
4 •
w m rn cPS
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b $ m x.50''
S
73 O m -Cp A-__...-° -----
ch ' /� surrcut COUNTY 1.
'Ff _
cii O 1 li X 77-i �® PEWIT*OPAL
t — o % t
as cotoraver I 1_3.. rA1101:Y saavOct am'
1 '.0 \_____.o Sys f c^"14 \ DATEQ q Zii*( AImo.'
nAPPROVED
c4 18.1 233.54' Z FOR MAXIMUM CF
to C S. 84'04'50' W P E C�1
UM=THREE YEARS FROM DATE OF AY'
er
_ 0kkitISII> y7z
(1) ' 4st° kte*/'
•. lee '
.,-,••.‘;1,...-ix,:•
AREA = 22,503 sq.ft. 1.
I1-.,..,,M44.. OR ADO/ TO THIS SURVEY IS VIOLATION �,�y�
2 OF THE AEW YORK STATE EDUCA LAW (''1 .h'Zl. ° ' '
r AS PER SECTION 7209-SUBDIVISION 2. ALL CERTFICA�T/ONS The locations of wells and cesspools �. ,� �, - r
VALD FOR THIS AUP AND COPIES ThEREOF ONLY F shown hereon ore from field observations / am vLqm /c$cCES
•5�6� 4 �2 p S, P.C.
"r' r*TO COMPLY M7TH SAID LAW THE TERM ALTERED BY and will abide by the conditions set forth therein and on Me
USED OY ANY ANO ALL SURVEYORS UT1L/ZIY6 A COPY permit to construct. P. O. BOX 909
)T ER SURVEYOR'S MAP. TERMS SUCH AS 'IYSPECTED' AND ELEVATIONS ARE REFERENCED 1230 TRAVELER S TREE 7
;HT-TO-DATE" ARE NOT NN COMPLIANCE WITH THE LAW. TO AN ASSUMED DATUL SOUTHOLD, N.Y. 11971