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JUDITH T.TERRY ' " Town Hall, 53095 Main Road
TOWN CLERK �
R P.O.Box 1179
� ,� Southold,New York 11971
REGISTRAR OF VITAL STATISTICS •
MARRIAGE OFFICER 5,r 1 Fax(516)765-1823
"`'' � 1'
RECORDS MANAGEMENT OFFICER 4f 4,00 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. 1330 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : MATTHEW G. HALLOCK
Address 1 : 4365 WELLS ROAD
City St Zip PECONIC NY 11958
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR NEW SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES.
Name Of Owner HALLOCK, TIMOTHY G.
u Mailing Address 1 P. O. BOX 200
City St Zip PECONIC NY 11958
Property Address 1 GREENWAY EAST
City St Zip ORIENT NY 11957
Tax Map No. section 20.00 block 2 lot 3.000
Cross Street MAIN ROAD
Building Permit Number Cross Reference:
Issue Date: 5/12/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
/33 O
$o Pe., --
4!:2%.
JUDITH T. TERRYTown Hall, 53095 Main Road
TOWN CLERK ® ,ter P.O. Box 1179
V W Southold, New York 11971
REGISTRAR OF VITAL STATISTICSV® ��' Fax (516) 765-1823
MARRIAGE OFFICER ... a'®I•1' Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER O,� 1% i
FREEDOM OF INFORMATION OFFICER -...���„po°��
OFFICE OF THE TOWN CLERK P ----i--- 2---[- L �1 1 - {f
TOWN OF SOUTHOLD --____ 1.
If ; �_. ___--- µ
I� ' MAY ' r
- 81995
TO: Southold Town Building Department
L
FROM. Linda ” i
T
J Cooper, Southold Town Clerk's Office -- � ' �_i
DATED: MAY 8, 1995 =r
Transmitted herewith is a copy of application No. 1379 for a Cesspool/
Septic Tank Construction Permit submitted by:
Matthew G. Hallock for Timothy G. Hallock •
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
,reccoommendations:
APPROVE �/
DISAPPROVE oo``
Comments: 7, G74 5e, = 3 "%'
//'d ff
Signati7V ''' f'1.--4
:,2- 9s
Dated
OFFICE OF THE TOWN CLERK ,.,'""" •
Town of SoutholdOf1Drob
Judith T. Terry, Town Clerk $�' �l/ Application No. 7G�
Town 'Hall, 53095 Main Road ;;. :G Construction
P. O. Box 1179 =v rn ; Alteration
Southold, New York 11971 •to
Telephone ,�Q�'' $10.00 - Residential J�
(516) 765-1801 -_"1 it �, ' $25.00 - Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
•
DATE /Way ) S
APPLICANT NAME: Pt Au 6( ikck
APPLICANT ADDRESS: 1366" ilk//S1W
/
SEPTIC )e,' CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
Net() sr4- ,�cyst, eeSialec cE? .
LOCATION MAP: • Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION :
OWNER OF PROPERTY: —7-7-ke Hui
OWNER MAILING ADDRESS: p.t , 8O c>2..00
ims--(r.
OWNER PROPERTY ADDRESS: gk eev t,/9-y er4s r
e),L EN
TELEPHONE NUMBER OF CONTACT PERSON: 76S"--Zig-Sr-
TAX
6S C1�/g-Sr-
TAX MAP NO. : Section O Block Lot 3
CROSS STREET: /144,01, Rd,
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of Applicant
RECEIVED BY: 1/a' //
•wn Clerk's Office
DATE: KS' c/ '" ,_
.
i•f- • . SUFFOLK CO.HEALTH DEPT.APPROVAL
`' .• • _ - , - H S. NO. `
-� _ . - ..MAP GR Pi2OPEITY
4 ' O t 2 IELt LV EYEE._ FOWL. . _
k' n ' t� STATEMENT OF INTENT
W Z P Zo Ay THE WATER SUPPLY AND SEWAGE DISPOSAL
Z� I Via, SYSTEMS FOR THIS RESIDENCE WILL
cj < ‘ CONFORM TO THE STANDARDS OF THE
I �p i N.33 r5orE. 160.0 0 V N OF SUThs0L,J 1t�,Y SUFFOLKOCO. DEPT. OF HEALTH SERVICES.
t�
. i i 9 t P2oP i Q APPLICANT •tfit„
IWCL /mi
• I I a PQOP. DRivt? /,/ I- SUFFOLK COUNTY DEPT. OF HEALTH
�� /1 SERVICES - FOR APPROVAL OF
1 L \ CONSTRUCTION ONLY
U ' DATE. •
I LI ! II Ifi S.REF.NO..
_ 1 ---- - 64' �.- -�_ Z �( APPROVED `
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1. gp• 1 1_ to 150:, C POOL, SUFFOLK CO.TAX MAP QES1CoN TLON:'
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r ! tj - - i PROP: [ . _ 'I "- - ..p Q•�+5' ti 1.0,119,50'..":-.14:,, --.
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