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JUDITH T.TERRY Town Hall,53095 Main Road
TOWN CLERK tPyr g t P.O.Box 1179
REGISTRAR OF VITAL STATISTICS ` O 647
1 Southold,New York 11971
MARRIAGE OFFICER `�� '111 Fax(516)765-1823
RECORDS MANAGEMENT OFFICER . ®? Iv0\®x.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. 1299 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : INLAND HOMES INC.
Address 1 : P. O. BOX 117
City St Zip MATTITUCK NY 11952
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. #R10-95-0032
Name Of Owner INLAND HOMES INC.
Mailing Address 1 P. O. BOX 117
City St Zip MATTITUCK NY 11952
Property Address 1 HENRYS LANE
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 74.00 block 1 lot 19.000
Cross Street COUNTRY ROUTE 48
Building Permit Number Cross Reference:
Issue Date: 3/23/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK ® 2teP.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS = �® Fax (516) 765-1823
MARRIAGE OFFICER .j` ��® �I' Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER 1 it
FREEDOM OF INFORMATION OFFICER �1
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department _ 8 1995 1; 1:1,:
FROM: Linda J. Cooper, Southold Town Clerk's Office , tz
DATED: March 8, 1994 TOWN 6 DEFT
SOUTHOLD
Transmitted herewith is a copy of application No. 13116 for a Cesspool/
Septic Tank Construction Permit submitted by:
Inland Homes Inc. •
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: .Q�e`'er / 5 C/7/D5/,.I '/d a ,5-o 03 z.
44--
S gnatur�'
eg7-.1/
Dated
CIO
OFFICE OF THE TOWN CLERK ,,,'"""
Town of Southold `••'s% .--- UL- c' - Application Nol2Y1�
Judith T. Terry, Town Clerk ,�•Og f: k" t.:
Town Hall, 53095 Main Road ; i _ .4 L Construction
P. O. Box 1179c `' • rn ; Alteration
Southold, New York 11971 .U1 .t.
'
Telephone ,.4%° , ,( ori $10.00 - Residential c�
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(516) 765-1801 = 1 %, ' $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 3/8/95
APPLICANT NAME: Inland Homes Inc.
APPLICANT ADDRESS: 315 West phailia Rd. , Mattituck,N.Y. 11952
SEPTIC CESSPOOL
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: Henrys La. ,Cutchouge
OWNER MAILING ADDRESS: PO Box 117,Mattituck,11952
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: 298-9596
TAX MAP NO. : Section 74 Block 1 Lot 19
CROSS STREET: Rt.#18
BUILDING PERMIT NUMBER CROSS REFERENCE:
"I Illintit N..;
?Vr
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Signa ture o" ' .plicant
RECEIVED BY:
T wn Jerk's Office "
DATE: �,�
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