HomeMy WebLinkAboutDempsey, John (2) o��FFou��o�
Town Hall, 53095 Main Road
un
�O P.O. Box 1179
Southold, New York 11971
JUDITH T.TERRY 1 FAX(516)765-1823
TOWN CLERK TELEPHONE(516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 489 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : INLAND HOMES, INC
Address 1 : 315 WESTPHALIA ROAD
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILY DWELLING WITH CESSPOOL SYSTEM.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES ON6/15/87.
Name Of Owner DEMPSEY, JOHN
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Mailing Address 1 P. O. BOX 5
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City St Zip CUTCHOGUE NY 11935
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Property Address 1 INDIAN NECK ROAD
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City St Zip PECONIC NY 11958
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Tax Map No. section 86.00 block 6 lot 29.000
------ --- ------
Cross Street ROBINSON ROAD
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Building Permit Number Cross Reference:
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Issue Date: 4/24/89 Judith T. Terry
-------- Southold Town Clerk
(TOWN SEAL)
1
771 i
APR 2 01989 i �O
J Ji
I)ET• GEf7' An Town Hall, 53095 Main Road
T: °' !"J. OF SOUTHOLC► V•o �
P.O. Box 1179
Ol• ��� Southold, New York 11971
JUDITH T.TERRY b= TELEPHONE
TOWN CLERK ` (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
To: Victor Lessard, Southold Town Building Department
From: Linda Cooper, Southold Town Clerk's Office
Dated: April 20, 1989
Transmitted herewith is a copy of application No. 500 for a Cesspool/
Septic Tank Construction Permit submitted by:
Inland Homes, Inc. for John Dempsey
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 recomPi'iendations:
APPROVE
DISAPPROVE
Comments:
Signature
- �/Dated
a' 9
AV
OFFICE OF THE TOWN CLERIC
Town of SoutholdCj o
Judith T. Terry, Town Clerk Application No.
Town Hall, 53095 Main Road Construction
P. O. Box 1179
Southold, New York 11971 Alteration`
Telephone Residential
(516) 765-1001 Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $ 10.00
DATE_&p ij_jq., 1989
APPLICANT NAME: INLAND.HOMES, INC._
APPLICANT ADDRESS: 315 Westphalia Road
attituck. N. Y. 11952_
SEPTIC CESSPOOL X
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
1- Family Dwelling
LOCATION MAP: Must be attached hereto before permit may he issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: John Dempsey
OWNER MAILING ADDRESS: P.O. BoxS
Cutchogue, N..Y.
OWNER PROPERTY ADDRESS: Indian Neck Rd. , Peconic , N. Y.
TELEPHONE NUMBER OF CONTACT PERSON: 298-9696
TAX MAP NO. : Section 086_Block_ 6_ Lot pel. 29
CROSS STREET: private road
13UILDING PERMIT NUM13ER CROSS REFERENCE:_
Signature oT A pllcan
Robert E. Hiltz
RECEIVED BY: �J ' --
Town Clerk's Officci��
DATE: C/ -o / � y
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SUFFOLK CO. HEALTH DEPT. APPROVAL ( .!
H. S. NO. t
STATEMENT OF INTENT
THE WATER SUPPLY AND SEWAGE DISPOSAL
.. ,_ ,..,. SYSTEMS FOR THIS RESIDENCE WILL
CONFORM TO THE STANDARDS OF THE
JZirl?v _�` �'(% �-'I";1Z SUFFOLK CO. DEPT. OF HEALTH SERVICES.
APPLICTT
SUFFOLK COUNTY DEPT. OF HEALTH
SERVICES — FOR APPROVAL OF
CONSTRUCTION ONLY JUN 16 198
DATE:
_". H. S. REF. NO. ;; c7 c
!! APPROVED:
;SUFFOLK CO. TAX MAP DESIGNATION:
DIST. SECT. BLOCK PCL.
OWNERS ADDRESS:
UTC H',:GLJ r--', NY. Irg55
DEED: L. 53 P.4 QEF)
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