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JUDITH T. TERRY � Town Hall, 53095 Main Road
TOWN CLERK ® P.O.1 P.O. Box 1179
REGISTRAR OF VITAL STATISTICS .�` Southold, New York 11971
MARRIAGE OFFICER �® CI) .;�� Fax (516) 765-1823
��® ;� Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 881 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : PECONIC PROPERTIES MANAGEMENT
Address 1 : P. O. BOX 1143
City St Zip CUTCHOGUE NY 11935
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILY DWELLING WITH CESSPOOL SYSTEM.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES ON 6/2/92.
Name Of Owner PECONIC PROPERTIES MANAGEMENT
Mailing Address 1 P. O. BOX 1143
City St Zip CUTCHOGUE NY 11935
Property Address 1 SOUTHOLD VILLAS - LOT 12
APPLE COURT
City St Zip SOUTHOLD NY 11971
Tax Map No. section 70.00 block 1 lot 6.000
Cross Street JASMINE LANE
Building Permit Number Cross Reference:
Issue Date: 7/20/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
JUDITH T. TERRY ' . `, Town Hall, 53095 Main Road
P.O. Box 1179
TOWN CLERK t c ) 1 G
REGISTRAR OF VITAL STATISTICS - 'P Z Southold, New York 11971
MARRIAGE OFFICER ' O ,4t Fax (516) 765-1823
OE® % + Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK lip [ i_6/f__E_ � }
TOWN OF SOUTHOLD 11 i! 4 r; �+1 1 i'
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Fs JUL 1 31992 'i6 x
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TO: Southold Town Building Department Vi\AL ._�j ��L++'�'
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FROM: Linda J. Cooper, Southold Town Clerk's Office TOWNOF S-O ► ',,.: ,,,
DATED: July 10, 1992
Transmitted herewith is a copy of application No. 905 for a Cesspool/
Septic Tank Construction Permit submitted by:
Peconic Properties Management Co. Inc. Lot 12 .
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 x
DISAPPROVE ,�
Comments: ,�QJ21. �, Y . re%
tier . CL4-61,_
Signature •
_q I S\°1 Z
Dated •
ti ,^9
OFFICE OF THE TOWN CLERK c.\\VFU/ -
Town of Southold Q%% ���y Application No. 965
Judith T. Terry, Town Clerk • , -<
Tvwn Hall, 53095 Main Road x1 :. Construction
P. 0. Box 1179xi
7 ,1J4'
Southold, New York 11971 't Alteration
Telephone ,!�l r ly�O Residential
(516) 765-1801 '� Non-Residential
TOWN OF SOUTHOLD
'I
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for - ,
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
., Permit No. •
Fee $
DATE /0 / 9 ?
APPLICANT NAME: / .�i .. ,.. f ej/& I •11/4/ ,,-
/ ' i./,. ' / i , •
O, &i/APPLICANT ADDRES : /1 2
' //93,-
/ / /
SEPTIC CESSPOOL
DESCRIPTI N OF PROPOSED CONSTRUCTION OR ALTERATION /
fri..44,a,•eiAvelba-a if,e, ed-7,,t4Z-- ,e-tryt
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONST ' UCTION O: ALTERATION:
OWNER OF PROPERTY: / r _, . �,.�. ��,1)..ge ,I°' �i�.' 1.444,17 ' / w
. OWNER MAILING ADDRESS: £ (l • � zi-- /&_
• ee.L791V a • // 93.5'
OWNER PROPERTY ADDRESS:
ff,a0 6=-tom/�'
'7 a �r u_A- 0 f.
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section 76 Block / Lot pp P
CROSS STREET: // �/- j.4j fel
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BUILDING PERMIT NUMBER ROSS REFERENCE:. Q0-791) :‘,1,-06(.4 o 90 /0 :e
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,/i/VAL) - aff/11.1-.7 .
Signature of Applicant
RECEIVED BY:
Town Clerk's Office ,
DATE: ,
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LANE
JASMINE
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• AREA-27,459 sq.ft. •
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C D,�cz” .77- - //•93s� SURVEY OF
LOT 12
• - "MAP OF SOUTHOLD VILLAS"
FILED MAP NO.
Prepared In accordance with the minimum
AT SOUTHOLD
standards title surveys as established TO 14/N OF SOUTHOLD
by the L.1.A.L.S and approved and adopted
for such use by The New York Slate Land
''l=v-.- SUFFOLK COUNTY, N.Y.•
Title Association. f•, ;- ;,,,.��^,
�,-_-if,. ie 1000-70- 01-P/O 06
The water supply and sewage disposal �''s�`" °-•� ��� ;'y;,
systems for this residence will conform 4�t°,I ,,
lo the standards of The Suffolk Countyv:.4,-.../,1
, I1 SCcue. I - 4If
Department of Health Services. Jam', 1 1992 �'° March 11, 1992
The locations of wells and cesspools shown hereon arehftc�' dJeld
observations and or from data obtained from others. H SLf!JI FS
� ' �ti S.rvF;,,0 LAND 9L
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES �o pili `G;4 F).
FOR APPROVAL OF CONSTRUCTION ONLY U $ ' ? V b•-' %sY ;,'21' ' N.Y.S. LIC. NO. 496/8
UN 021 4 _y !, ;.- ,*
DATE J HS.REF.NO. ••/ I �� - 3' I EYORS, P.C.
• 1 04943,E 6/9090
APPROVED D
SOUTHOLD, N.Y. 11971
- - _ 87-670 ( 12)