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OFFICE OF THE TOWN CLERK c3IFO(K-,-
Town of Southold
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road . 8
P. O. Box 1179 t•r1t =�;
•
Southold, New York 11971 O 0 •�
Telephone o!
(516) 765-1801
' TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 29 ; Residential xx
Non-Residential
Fee $ 10.00
Septic Cesspool xx
PERMIT ISSUED TO:
NAME: Inland Homes, Inc.
ADDRESS: 315 Westphalia Road
Mattituck, New York 11952
DESCRIPTION OF PROPOSED CONSTRUCTION or ALTERATION
New Single Family Dwelling
LOCATION OF PROPOSED CONSTRUCTION or ALTERATION:
OWNER OF PROPERTY: Lino and Helga Quirko
OWNER MAILING ADDRESS: 49 West 71st Street , Apt. 9
New York, New York 10023
OWNER PROPERTY ADDRESS: 1440 Green Hill Lane
Greenport, New York
TAX MAP NO. : Section 33 Block 3 Lot 3
CROSS STREET: Sound Drive
BUILDING PERMIT NUMBER CROSS REFERENCE: 151982
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JUdit .T�
Southold Town CIer�
DATE : September 8. 1986
(TOWN SEAL)
OFFICE OF THE TOWN CLERK
Town of Southold
Judith T. Terry; Town Clerk Application No. 23
Town Hall, 53095 Main Road Construction
P. 0. Box 1179
Southold, New York 11971 Alteration
Residential
Telephone
(516) 765-1801 Non-Residential
TOWN OF SOUTHOLD
RFCFI PE0 SOUTHOLD WASTEWATER DISPOSAL DISTRICT
SEP 0819U
APPLICATION
Tnwo G sOUthold
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 19?7: •
Fee $10:00 ;
DATE August 29, 1986
APPLICANT NAME: INLAND HOMES, INC. Lino & Helga Quirko
APPLICANT ADDRESS: -14210xGieg14x14gItxMgNIcxgYN141415Z55XxN3ix1C)
315 Westphalia Rd. , Mattituck, N. Y. 11952
SEPTIC CESSPOOL X
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
1- Family Dwelling
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF,.PROPERTY: Lino & Helga Quirko
OWNER MAILING ADDRESS: 49 West 71st Street Apt. 9
New York, N. Y. 10023
OWNER PROPERTY ADDRESS:' 1440 Gi%e"Hill Lane, Greenport, N. Y.
TELEPHONE NUMBER OF CONTACT PERSON: 298-9696
TAX'NAP NO. : Section 33 Block 03 Lot 03
CROSS STREET: Sound Drive
BUILDING PERMIT NU BER CROSS REFERENCE: ( 57 eigZ
Signature of Applicant
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RECEIVED BY: dr&,64 I ' �;a
Town -ries Of 'ce
DATE: � ._..r.�_
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LINO QUIRK() L.. ,� ., 7 4
HELGA QUIRK() o, ��iv %\
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SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES ( p, `
FOR/ (PPRO/AL OF CONSTRUCTION ONLY VR
,�i G�
ATE (I' S RAF. NO. C r� t ' 39
7 7 4
PPROVED 1�!/� SURVEY ®F
L 0 T 137
°B MAP OF EASTERN SHORES ss
Tho water supply & sewage disposal sys•
teF1 VE
rns for this residence will conform to the ��O N
standards of the Suffolk County Depart. FILED DEC . 3 I , 1968 FILE N O. 5 2 3 4
merit of Health Services,
j A T GREENPORT
9 los, 9,u aff- yG TO WN OF SOU THOLD
315 Westphalia Rd. SUFFOLK COUNTY1 N.Y.
�QL4 hki& . 1000 - 33 - 03 - 03
' co \,,,, A. I!V
0 „‘„ SCALEu
c.) -? t ki ' �o ® i I = 40
d, R '4 JUNE 16 , 16
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Prepared in accordance with the minimum
�� / standards for title surveys as established by
,, ;'9j. o, 4966'%0* ,, Y. S. LIC. NO. 4 9 6 6 6
,�0d the L.I.A.L.S. and approved and adopts '
word for such use by The New York State .,
i ECONIC , YORS a ENGINEERS , P. C . ., Association.
If 516 ) 765 - 5020 ELEVATIONS ARE REFERENCED
P. O. BOX 909 TO AN ASSUMED DATUM s
MAIN ROAD
SOUTIIOLD , N.Y . 11971
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