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` ® Town Hall, 53095 Main Road
JUDITH T. TERRY o
TOWN CLERK ® . P.O. Box 1179
REGISTRAR OF VITAL STATISTICS .�` Southold, New York 11971
MARRIAGE OFFICER Cr. � 1� Fax (516) 765-1823
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�®� , ii., 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. 875 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 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 6
JASMINE LANE/APPLE COURT
City St Zip SOUTHOLD NY 11971
Tax Map No. section 70.00 block 1 lot 6.000
Cross Street JASMINE LANE/APPLE COURT
Building Permit Number Cross Reference:
Issue Date: 7/20/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH
JUDITH T. TERRY ; Town Hall, 53095 Main Road ,
TOWN CLERK t ) P O. BOX 1179
REGISTRAR OF VITAL STATISTICS : Southold, New York 11971
MARRIAGE OFFICER
V10), O _�' Fax (516) 765-1823
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P. Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK rrl
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TOWN OF SOUTHOLD ,'f; 91
! ', 4 JUL G 3 19921111,
TO: Southold Town Building Department ` 4
FROM: Linda J. Cooper, Southold Town Clerk's Office"—,, ?�i�° LI
DATED: July 10, 1992
Transmitted herewith is a copy of application No. 899 for a Cesspool/
Septic Tank Construction Permit submitted by:
Peconic Properties Management Co. Inc. Lot 6 •
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: . *Ai .,..
Signature
S-\\c;\
Dated
4-4•15-
OFFICE OF THE TOWN CLERK Oc FOLe
od
JudithTT�.v Terry, Townn of lClerk .rte` =�; ' Application No. gS
Town Hall, 53095 Alain Road o ±•1 Construction
P. O. Box 1179 �t� w.; .
Southold, New York 11971 O. �. -�'O� Alteration
Telephone / X01 r ���t� Residential
(516) 765-1801 „�'' Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
I
•
SEPTIC TANK or CESSPOOL
Permit No. •
Fee '$
DATE /1 / 97 "---
APPLICANT
/ / s-APPLICANT NAME: / _/I .44_ if �1.f! ' 41 � .
APPLICANT ADDRESS: IP.° tgr L 11 3
eAre .1,.(4„0_, //935—
SEPTIC
/935—SEPTIC / CESSPOOL
DESCRIPTI N OF PROPOSED CONSTRUCTION OR ALTERATION /
r,f.../44‘,"AreleilA
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONST ' UCT ION O: ALTERATION:
OWNER OF PROPERTY: 4,0/ ', ,_, � / p�� 0 �' LeA - / / r
OWNER MAILING ADDRESS: `�O• //V.
1 � I // x'3.5'
OWNER PROPERTY ADDRESS: , /; // A�J 4
beelka
a a. my.
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section Block J Lot f/0
/
CROSS STREET: �/ ,./y
BUILDING PERMIT NUMBER ROSS REFERENCE:. 00`79 ,` 20
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,i//!��J�'Xv a'j'T .
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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PLEASE NOTE ;i
Sanitary system is not to be :I
placed under driveway area. ,I _
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AREA = 10,768 sq. ft. •
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e2e-rix-i-'6' -/a1- 2'-/I-Z-Q--4------- / / / tew..,1-d-r2-Y
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SINGLE FAMI - WELLING.OML`l SURVEY OF .
(PIKES' 3 ` EARS ROOD oFAFF VAi • LOT 6 •
"MAP OF SOUTHOLD VILLAS"
• FILED MAP NO.
Prepared In accordance with the minimum AT SOUTHOLD
standards for Lille surveys as established ,
by the L.I.A.L.S. and approved and adopted TOV/N OF SOUTHOLD
/or such use by The New York Stole Land SUFFOLK COUNTY, N Y.
Title Association. __ •
1000- 70- 01-PlO06
The water supply and sewage disposal
systems for this residence will conform Scale: rsi= 30'
to the standards of The Suffolk County 'r March 11, 1992
0 a
�menl//of//Heal Services.
Tlfe locations of wells and cesspools shown hereon are from field .
observations and or from data obtained from others. f,� rte,
,,,,.
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SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES kR3 J1"i6�* a!(j�,.,.,.,. � `6-:•to
FOR APPROVAL OF CONSTRUCTION ONLY `,,,, ,,� , 10.„
Q • Nr ` e 5l �.� / N.Y.S. LIC. NO. 49618
DATE JUN 0 2,1( s. REF. NO. C?'S o--43 �8 1992 '�`F? CONIC UR,Y/EXDRS, P.C.
�� L� A(Ty T p, MA�1�RC4
• F FP
-APPRovED _ Sfifff��S SOUTHOLD, N.Y. 11971
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