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JUDITH T.TERRY ® :'� `= �: Town Hall 53095 Main Road
TOWN CLERK ; .' P.O.Box 1179
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REGISTRAR OF VITAL STATISTICS Southold,New York 11971
Fax(516)765-1823
MARRIAGE OFFICER
N71* �1
RECORDS MANAGEMENT OFFICER ®� 000 Telephone(516)765-1800
FREEDOM OF INFORMATION OFFICER „ ,••�o
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1386 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. #R10-95-0036
Name Of Owner THOMAS PAPATHANASOPOULOS
Mailing Address 1 C/O INLAND HOMES
P. O. BOX 117
City St Zip MATTITUCK NY 11952
Property Address 1 ALVAHS LANE
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 101 .00 block 1 lot 16.004
Cross Street NORTH ROAD
Building Permit Number Cross Reference:
Issue Date: 9/14/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY % _, Town Hall,53095 Main Road
TOWN CLERK ; ga z % P.O.Box 1179
O 'll Southold,New York 11971
REGISTRAR OF VITAL STATISTICS Fax(516)765-1823
MARRIAGE OFFICER ..V* cs' 1
• Telephone(516)765-1800
RECORDS MANAGEMENT OFFICER i
FREEDOM OF INFORMATION OFFICER ,'i��� ^ry
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OFFICE OF THE TOWN CLERK . < < `�=./ /? -+
TOWN OF SOUTHOLD S, p I
TO: Southold Town Building Department ill
FROM: Linda J. Cooper, Southold Town Clerk's Office , -2---,(21-:,s-,1-1-,�''��
2-,firAi
DATED: September 11, 1995 ▪ `0,_ ii
Transmitted herewith is a copy of application No. 1438 for a Cesspool/
Septic Tank Construction Permit submitted by:
Ingoland Homes Inc. for Mr. and Mrs. Thomas Papathanasopoulos
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.
(cc,
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 )� '. if/0 �, 60,3
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OFFICE. OF THE TOWN CLERK
Town of Southold
Judith. T. Terry, Town Clerk Application No./5i3
Town Hall, 53095 Main Road Construction
P. 0. Box 1179 Alteration
Southold, New York 11971
Telephone Residential
(516) 765-1001 Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee '$ /
DATE 9/11/95
APPLICANT NAME: Inland' Homes Inc.
APPLICANT ADDRESS: PO Box 117,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: Mr_&'7Mrs.Thomas Papathanasopoulos
OWNER MAILING ADDRESS: PO Bpx 117 Mattituck,N.Y. ,11952
OWNER PROPERTY ADDRESS:' Lot#2,Alvahs La. ,Cutchouge,N.Y. ,
TELEPHONE NUMBER OF CONTACT PERSON: 298-9696
TAX MAP NO. : Section 101 Block 1 Lot 16.4
CROSS STREET: North Road
BUILDING PERMIT NUMBER CROSS REFERENCE: Pending
/I OP
Signatur' of Mr•Iicant
RECEIVED BY: RowVED
Town Clerk's Office
DATE: SEP 1 1 1995
town Clerk Southblit
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CV4C-.)- . _ i C �Imr+:J-P IV 5 - EXPIRES Feld-FROM
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. R3, Da'tE�F APPROV`�It.
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°.E .: !, _, zl. -:� I i { STATEMENTQF IN :
- • . r- ,.f'`' "�= STAT
r =,"2�ir „�,, �.-! .� �-- ,o;--------,--,4-.0,..;,:t• � �" E THE WATER-SUPPLY AND'SEYVAGE-DISPOSAL
ti - '�� •• i._ �._.__.. - - 0 1 L • SYSTEMS FOR THIS'- RESIDENCE _sW.ILL
�.„ - ` 3 ; . ' . ., �- _ - > . - = � — N t1 I CONFORM TO
y �, •+ • THE `STANDARDS`,•OF;;.THE . _
• / ; Iv, • 1^ �' - ,•SUFFOLK CO-• DEPT.•,or HEALTH-,SER I
• I • V EES:
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- . ,_ - , . APPLICANT • ---..;',"•,,_,, , ...
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: •- - -- : '. ' : — 2-s : " ¢ i , DATE: MAR 2 Lr 1�.TJ
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,/� _ cc'► SCALE-.60.::.1, _ , . _ ITION:
+ -�' - ---�*-- ate' f[�s I DIST. SECT. BLOCK • P
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.► _ _ _ '. �_._ ____ - OWNERS ADDRESS: - •. :
' i' • `= 28-37'20 ST.
- - j• �__•• • Std MN-.11 3 - - .
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't�' :_WEi:I:'
. , .� ' O,� DEED: i:: P. • _,
PLEASE NOTE `�
between `'�" =TEST HOLE STAMP
Minimum distance ,well , . • , . ' - • .F
- and cesspool is,to be 150 feet. • .
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