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ELIZABETH A.NEVILLE �O �*-1‘
y, Town Hall, 53095 Main Road
TOWN CLERK c 1 �` P.O. Box 1179
c/3 Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
Fax (516) 765-1823
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER 0 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. 2206 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : INLAND HOMES INC
Address 1 : PO 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. REF #R10-99-0053
Name Of Owner INLAND HOMES INC
Mailing Address 1 PO BOX 117
City St Zip MATTITUCK NY 11952
Property Address 1 785 SHEPARD DRIVE
City St Zip MATTITUCK NY 11952
Tax Map No. section 78.00 block 1 lot 21 .000
Cross Street GLENN ROAD
Building Permit Number Cross Reference:
Issue Date: 12/21/99 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH
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ELIZABETH A.NEVILLE �^4.•4z5
Gy�•• Town Hall, 53095 Main Road
TOWN CLERK o - P.O. Box 1179
y Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS vo Ply t
MARRIAGE OFFICER
Fax(516) 765-6145
RECORDS MANAGEMENT OFFICER 0�/ Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER ' 111 i4‘;810.
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: December 9, 1999
Transmitted herewith is a copy of application No. 2294 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:
APPROVE
DISAPPROVE
Comments:
ignat
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Dated
OFFICE OF THE TOWN CLERK "'
TOWN OF SOUTHOLD **3
�� = Application No. ,2UZ yy
F1.i7ABETH A.NEVILLE,TOWN CLERK
f,/ .�.; Construction i
P.O.BOX 1179 1.
SOUTHOLD,NEW YORK 11971 r
�
Alteration
�
Telephone ,j� 'b .' $10.00 - Residential
(516) 765-1801 = 11 �,"r'�, $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCT ION or ALTERAT ION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE 12/9/99
APPLICANT NAME: Inland Homes
APPLICANT ADDRESS: p0 Box 117,Mattituck,NY, 11952
SEPTIC CESSPOOL xx
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
New single family dwelling
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: Inland Homes
OWNER MAILING ADDRESS: PO Box 117,Mattituck, 11952
OWNER PROPERTY ADDRESS: Same as above 7. 'is-3
TELEPHONE NUMBER OF CONTACT PERSON: Rob/298-9696
TAX MAP NO. : Section 78 Block 01 Lot 21
CROSS STREET: Glenn Rd.
BUILDING PERMIT NUMBER CROSS REFERENCE: pending
Nih.Robert Hiltz 4.401
Signature of Applicant
RECEIVED BY:
areintle.4 Town Clerk's Office
DATE 9 999
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ANY ALrrR'ATON05)'`A&DITION TO THIS SURVEY IS A VIOLATION
OF SECTION 72o ''OF- THE NEW YORK STATE EDUCATION LAW
EXCEPT AS PER SECTION 7209-SUBDIVISION 2 ALL CERTIFICATIONS
HEREON ARE VALID T9R. THIS MAP AND COPIES THEREOF ONLY IF
SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR
WHOSE SIGNATURE APPEARS HEREON.
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SURVEY OF PROPERTY
AT SOUTHOLD
TOWN OF SOUTHOLD
SUFFOLK COUNTY, NEW YORK
1000-78-01 _21
SCALE: 1" =30'
MARCH 3, 1999
OF i OLI4 COUNTY DITARTMEsIT OF t2ALT H S"RVICES
PEPIETRAC A.'"72+OV'ALC7'0131,$ U :!O.WFORA
7t� LikAiE%Y X ,vsri " iLY
DATE 9 ? ` i?7 .11,170.
APPROVED
FOR MAXIMUM OF BEDROOMS
EXPIRES THREE YEARS FROM DATE OF APPROVAL
ii-- /1r,.� -6 7::(,,,.. " i,U-P2e/e�?� G11� "dG�G '�
The locations of wells and cesspools v , /C
shown hereon are from field observations
� `� �~_
and or from data obtained from others. Cx^ ' Ge---e-644-/a""' -c-c4 . -�x/a2
v.-C"--f /C.P E' j -e a2� ".-4 /. /z' C
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-4. l� 6)-71 d a �
I am familiar with /he STANDARDS FOR APPROVAL , /rte G- -
AND CONSTRUCTION OF SUBSURFACE SEWAGE
DISPOSAL SYSTEMS FOR SINGLE FAMIL Y RESIDENCES ,/i(e �s , ,tit-GL'� —
and will abide by the conditions set forth therein and on the
permit to construct. / p � � (� � .
(. T ,t 7Z-4,-"Le
THE SUFFOLK
■ =monument .\OE NEWS,o_ C
AREA = 20,535 sq. ft .' 1 1'T.MST.4 � 7,1,P/14/0,1740,feA,"/"„c, //
F
LOT NUMBERS REFER TO MAP OF WEST 2in
/ �7 'I S LIC NO 49618
; . YAC...
CREEK ESTATES" FILED IN '(
ONI�� I ,',)��rEYIRS P C
COUNTr CLERK'S OFFICE ON AUG '9.
'963 AS FILE NO 3848 •-;,.) �F'````� `507 . .
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SOU - . a • . . 11971 99 - 134