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JUDITH T. TERRY ' ��+ Town Hall, 53095 Main Road
k P.O. Box 1179
TOWN CLERK ® '1N v ��
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
��' Fax (516) 765-1823
MARRIAGE OFFICER ® .�
�Jhi� ®��! 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. 871 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : PECONIC PROPERITIES 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 2
JASMINE LANE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 70.00 block 1 lot 6.000
Cross Street BLOSSOM LANE
Building Permit Number Cross Reference:
Issue Date: 7/20/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRY y Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS i&PSouthold, New York 11971
MARRIAGE OFFICERC) Fax (516) 765-1823
Telephone (516) 765-1801
fTh
OFFICE OF THE TOWN CLERK 1'1:01
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: LindaJ Cooper, Southold Town Clerk's Office �•�°��°�' ��u ��
DATED: July 10, 1992 OF
Transmitted herewith is a copy of application No. 895 for a Cesspool/
Septic Tank Construction Permit submitted by:
Peconic Properties Management Co. Inc. Lot 2 •
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: acut
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Signature
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Dated
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OFFICE. 'OF THE TOWN CLERK •
Town of Southold "c
Judith
Judith T. Terry, Town Clerk �I� ` ` y' Application No.
Town Hall, 53095 Main Road o ' � Construction
P. 0. Box 1179 crl
Southold, New York 11971 Alteration
Telephone 1 x t ly,�fffN6VResidential
(516) 765-1801 „� Non-Residential
TOWN OF SOUTHOLD • ,
SOUTHOLD WASTEWATER DISPOSAL DISTRICT t'
APPLICATION
• for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATEdil /�� / 9Y—
•
APPLICANT NAME: ��► g,z2p, ./� C�LP /�J
APPLICANT ADDRESS: 0, Z.. /1 2
�/ _ //93,5--
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SEPTIC CESSPOOL
DESCRIPT/JI N OF PROPOSED CONSTRUCTION OR ALTERATION
• A L.
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONST ' UCTION O: ALTERATION:
OWNER OF PROPERTY: .44 /;`, _,_ ���� ��� � - �l2 - J .
OWNER MAILING ADDRESS: a--;./0- o //Vi
• &all/7U° , // 93.5
• OWNER PROPERTY ADDRESS: , F,• ;/ ,("� 4-0 7--
° //19t "cff
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section 76 Block I Lot 161,40 •6
CROSS STREET: A/a/de_ /, •
BUILDING PERMIT NUMBER ROSS REFERENCE:_ c O`]9 Q �q p to
64/ / , ,
.///(LdaA/C-1 aliaL7 •
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
•
DATE: S
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VACANT CARP .
AREA_ = 45,004 sq. ft. • I SC t to be
. ',n Sanitary system area•
g,eivriL �`G C��` placed under drive�ay
aC) . //5/3 •
. //935"-- I SURVEY OF
..-- CulfrciatEFAMkV El.L G ONLY LOT 2
EXPIRES 3 YEARS FROM DATE CFAPPROVAL EMAP OF SOUTHOLD vaLAs"
FILED MAP NO.
Prepared in accordance with the minimum AT SOUTHOLD
standards for title surveys as established
by the L.LA.L.S. and approved and adopted TOWN OF SOUTHOLD
for such use by The New York Slate Land SUFFOLK COUNTY, N Y.
•
Title Association. I
The water supply and sewage disposal 1000- 70-01-P/o 06
systems for this residence will conform _ I
to e standards of The Suffolk County SCa16� "- 40
e a Im nt of Heal Serv1� March 11, 1992
he locations/of wells and cesspools shown hereon are from field f--- -
observations and or from data obtained from others. 4\_PND,9
R R / ate Q tri
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES '.4:.74111) e,1 J °+r '', -� Q
FOR APPROVAL OF CONSTRUCTION ONLY I w9 It
� MAY 28 1992 ;s 'a ' ' , W4' N.Y.S. LIC. NO. 496
JUN 021 f dog a e,, , _ ria
DATE S. R a .NO. lip call ` ..I-VEYORS, P.C.
S.C. RCPT OF 5020
rit p .� HcAL7N SERVICES 909 '
fl I. APPROVEIS ;, �//L!� �tS MAIN ROAD
„M.,,., ,, SOUTHOLD,_N.Y.,, . //97/