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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK ® T P.O. Box 1179
REGISTRAR OF VITAL STATISTICS � Southold, New York 11971
MARRIAGE OFFICERyQ ®�' , Fax (516) 765-1823
le1a Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 974 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : PECONIC PROPERTIES MGT.
Address 1 : P. O. BOX 1143
City St Zip CUTCHOGUE NY 11935
Descripton of Proposed Construction or Alteration
CESSPOOL SYSTEM FOR A NEW SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES ON 3/30/93.
Name Of Owner PECONIC PROPERTIES MGT.
Mailing Address 1 P. O. BOX 1143
City St Zip CUTCHOGUE NY 11935
Property Address 1 JASMINE LANE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 70.00 block 1 lot 6.000
Cross Street APPLE COURT
Building Permit Number Cross Reference:
Issue Date: 4/15/93 Judith T. Terry
Southold Town Clerk
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JUDITH T. TERRY • 1� 4.
Town Hall, 53095 Main Road
TOWN CLERK i T 1 P.O. Box 1 179
REGISTRAR OF VITAL STATISTICS , I VI • • Southold, New York 11971 •
MARRIAGE OFFICER / i ® � •� Fax (516) 765-1823
', /011.° •
. b , Telephone (516) 765-1801
•
•
OFFICE OF THE TOWN CLERK 1 Lir_ .._ _si d'
TOWN OF SOUTHOLD ir\ I APR - 61993 fI
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BLDG.TO: Southold Town Building Department
TOWN OF SOUTHOLD
FROM: Linda J. Cooper, _Southold Town- Clerk's Office
DATED: April 6, 1993
Transmitted herewith is a copy of application No. 1001 for a Cesspool/
Septic Tank Construction Permit submitted by:
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 "IN
DISAPPROVE
Comments: o ,c.+.,sti.� � o,,, a uc�
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Signature
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Dated
•
OFFICE OF THE TOWN CLERK r�(�.
Town of Southold
Oma, ✓
Judith T. Terry, Town Clerk �;' , Application No./O0 /
Town Hall, 53095 Main Road c i.��• , �`' �'
P. O. Box 1179 �1K' Construction
Southold, New York 11971 % �''� '�`' Alteration
'Vc
Telephone r` jib Residential
(516) 7 65- 1301 �,�'"
Non-Resi den tial_
• TOWN OF SOUTHOLD
•
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
•
•
APPLICATION
•
•
for
CONSTRUCTION or ALTERATION PERMIT
•
•
SEPTIC TANK or CESSPOOL
f•
Permit No. •
Fee .$
DATE e4/93
APPLICANT NAME: /46rkt.A•C 74
APPLICANT ADDRESS: J2O, odox J/ cI?
o-tT �.r � / � 3 )
SEPTIC CESSPOOL -
DESCRIP ION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALT- RATION:
OWNER OF PROPERTY: /CUK.• . �1 .0 . J G 7
OWNER MAILING ADDRESS: 4,< 3 0,/, -r Pi/
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OWNER PROPERTY ADDRESS:
•
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section 76 Block 6/ Lot
•
CROSS STREET: ' /`� 41
•
BUILDING PERMIT NUMBER CROSS REFER' iE:_�
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•
•
•
•
• I / / •
• 1 a
ig a ure of Applicant
RECEIVED BY: /j..././ ,' J
T wnlerk's Office
DATE: 64 ��3
1
9UFFOl�C COUNTY DEPARTMENT OF HEALTH SERVICES
P$ _FOR APPROVAL OF CONSTRUCTION ONLY , "S—i.
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=�-9 - DAT AR 3 0 1993 HS. REFS NO.
9 3 ' -a 3
wI �e� a�
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S 6g S }�67. �� APPROVED �1 d / i ��
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,� • E .o G 8•00•
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SINGLE FAO.I°�.Y DWELLNG ONLY mi
ti°� J'4 oQ tPIRES THREE YEARS FROM DATE OF APPROVAL
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nor �� sV` •
SURVEY OF p
O ti LOT 5 -
` - "AMP OF SOUTHOLD VLLASs SECTAAN TWO" - ;,:_
AT SOUTHOLD kr
/40 *
rs a, ZT' TOWN OF SOUTHOLD
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'' SUFFOLK COUNTY, N. Y.
...g• Q 10oo- 70- 01-P106
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'9i Scale: 1"= 40'
�; 0 Mar. 15, 1993
D \�Qe O F'ECiO�NIC PI'Or•Ck!1:._, ;tni•i',:,:_,•,, , —
..) b\IrPV 1.9 CU7,,;!or3U ;a ) 1011,
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Eos®�•n' pc
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,, AREA = 22,201 sq. ft OF NES
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II N/p/F A[+p/wE ao•00 — r>993 5��oa f.MET QfoiP
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H/[[ S C. DEPT OF i n • t
BU/ HEALTH SERVICES * f M1s,v1;,, 3
0Rp The water supply and sewage disposal �,F,Y;4 i� . oc�ti/,, .S LIC. NO. 49618 1
Prepared in accordance with the minimum , systems for this residence will conform ► al .
standards for title surveys as established to the standards of The Suffolk County - r,rP • r- , P.C.
The locations of wells and cesspools .- by the L.I.A.L.S. and approved and adopted Department of Health Services. - (516 •� ril •�• rS
WR5:
shown hereon ore from field observations for such use byThe New York Slate LandP. 0. :• -S9
and or from data obtained from others. Title Associatio . • ELEVATIONS N SMu ARE A4 UM. MAIN ROAD
SOUTHOLD, N.Y. 1197/