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JUDITH T.TERRY o Town Hall,53095 Main Road
TOWN CLERK c g 4 P.O.Box 1179
REGISTRAR OF VITAL STATISTICS �, Southold,New York 11971
MARRIAGE OFFICER O `� / Fax(516)765-1823
RECORDS MANAGEMENT OFFICER � ®� VIS.' 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. 1366 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : LYNCH HOMES, INC.
Address 1 : 321 CR 39A
City St Zip SOUTHAMPTON NY 11968
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. SCHD REF. #R10-95-0077
Name Of Owner HENNESSEY, DONNA AND THOMAS
Mailing Address 1 P. O. BOX 450
City St Zip CUTCHOGUE NY 11935
Property Address 1 OLD SADDLE LANE
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 95.00 block 4 lot 18.010
Cross Street GOLD SPUR
Building Permit Number Cross Reference:
Issue Date: 9/14/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
/3 6
64 4269,6,
JUDITH T. TERRY
Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
_,. Southold, New York 11971
REGISTRAR OF VITAL STATISTICS - �" Fax (516) 765-1823
MARRIAGE OFFICER tr
RECORDS MANAGEMENT OFFICER _ __i®® ����. Telephone (516) 765 1801
FREEDOM OF INFORMATION OFFICER = �>�ii/��r11.. -
OFFICE OF THE TOWN CLERK --_--- i — - -_
TOWN OF SOUTHOLD I 1 , (-� if � 11 '[\Y1
11
JUL 2 8 1995
TO: Southold Town Building Department I,f-,_, _
FROM: Linda J. Cooper, Southold Town Clerk's Office , es.?L.D.G. e. II
DATED: July 28, 1995 TOWN OF SOUTHQ!P_�_.
Transmitted herewith is a copy of application No. 1417 for a Cesspool/
Septic Tank Construction Permit submitted by:
Lynch Homes, Inc. for Donna & Thomas Hennessey
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: ✓/ c_ . �1 c�c/ a *3/ 93----
ignature
Dated/
OFFICE OF THE TOWN CLERK c0FDLA
Town Of Southold mss• CSG Application No.
Judith T. Terry, Town Clerk • pp I f7
... /
Town Hall,. 53095 Main Road o ;T, � ���.��� - � Construction
,P. O. Box 1 179 un �'
Y O. c Alteration
Southold, New York 11971 p-
Telephone 1 x [ Residential
(516) 765-1801 - Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or'CESSPOOL
Permit No.
Fee $
DATE 7/21/93—
APPLICANT NAME: LL/MCl/ /fcj m E3, rNt--
APPLICANT ADDRESS: 32( A
5007-1+19-e P ro,.J N c/ 09(0F3
SEPTIC (" CESSPOOL ✓
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
SePTiC, CESS Poo c_
SEEATTFSC /-te-fi HD PP ILL) vC76 sv21/1 :�.
ow i/�.
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: 7o,c1/c/4 c TH-per ,-5 pextiIESSey
OWNER MAILING ADDRESS: Pp /3cX �5 p
C v T-c_Hc o6 AJy //q3
OWNER PROPERTY ADDRESS: (QLj 5, boc_E L$A( Tc-/f-vgiJ !
TELEPHONE NUMBER OF CONTACT PERSON: 2z33 -t0o0c
TAX MAP NO. : Section 095- Block Lot / ? /(O
CROSS STREET: 67Qcf .5 Poe.
- BUILDING PERMIT NUMBER CROSS REFERENCE:_
Signature of Applicant
RECEIVED BY: 111
/own Clerk's Office
DATE: •
weu l ! j SUFFOLK CO HEALTH OEPT APPROVAL
MAP ?!--2c._.)— c` H S NO ••�`_
'1,1
���%�
SINGLE FAMILY DWELLNG ONLY
I . w ,— r - '" , {;t -
EXPIRES THREE YEARS FROM:ATE OF SPPROVA:^ . . - . ,, . ;JI •, i 1,,L2E5,1 -
'___ O _1 __ _ ____ ;� v -+ ----•-- STATEMENT OF;INTENT
S. \ \ j Ti _ 1 AT THE WATER SUPPLY AND SEWAGE DISPOSAL
I AUT C OGs.:E SYSTEMS FOR THIS RESIDENCE WILL
\ OF SOL T OLS ' VY 1 CONFORM TO THE STANDARDS OF THE
( ! I ! SUFFOLK CO. DEPT, OF HEALTH SERVICES.
` GOLD SPU4Z. -ar'-1I2EBT' S5
\\1 •}I 5� i (51 APPLICANT
� EDGE OF SLACILTOP
RESEfcVED FOP. N.5942-35 E. �� • in 53 .1 t SUFFOLK COUNTY DEPT. OF HEALTH
POSSIBLE FUTURE �--_ 55''. _EASEMENT ' % :� SERVICES — FOR APPROVAL FOR
HIGHWAY DEPICATIOI4 - d q{1j�
X25'w10.f� \\ / c P40L —._- !1 \\ CONSTRUCTI(p1y 6 OY
- ---- •50 � ,�•pp�2'�,�°�. ` F \ ! DATE: �i+n
�o PD1P•wELL� t .•• -� / \( H.S.REF NO.-RIO-96-001-1
•
(\A N W z LI-- g N6.1 I APPRc�v
•
t\ ��?ETACLE ��I / SUFFOLK CO.TAX MAP DESIGNATION:
MC\,), - R P p 111» ¢Id• 50 ' .f.1 I // " DIST SECT BLOCK PCL.
,J.51` ,-F ,$5,04- \ �, ea° 1 ul 32) / ; 1000 095 4' 1g10
• IVP 1/4,- 1 , OWNERS ADDRESS. •
�. \ !. J VI
Z THE WATER SUPPLY AND SEWAGE DISPOSAL
/ .r SYSTEMS`FOR THIS RESIDENCE WILL CONFORM I • LOCUST-QOAD o
\ / P.O..f30X ay
�1 ` IO 1, / PROPNCEVTt/ '� TCOUNTY FIE Spp�THENT0OFTHHEALTH FSERVICES. i WADf�+16 f2t1/e$,ba�b 2
\ WELL - q - 54
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(-RESIDENCE) 6` v� •/ 40 e4 5 o°rnp ytalmwtwanDorslCaV°�
O41 a o f UrPC COUNTY ROAD 39A
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,) _(� q (516) 283.0009
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LOT MOS.REFER TO MAP OF CfLEGC W_ - •—
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ta LICENSED LAND SURVEYORS I 1
,g.;%. GREENPORT NEW YORK
•ELWYN/POST `.91319
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