HomeMy WebLinkAboutShanks JUDITH T.TERRY
�� �„" � � Town Hall,53095 Main Road
TOWN CLERK k ; ,- Y.=- g P.O.Box 1179
REGISTRAR OF VITAL STATISTICS "10 Southold,New York 11971
MARRIAGE OFFICER , -v ,�� Fax(516)765-1823
RECORDS MANAGEMENT OFFICER -. ®� ,.s�G, �i,s��� Telephone(516)765-1800
FREEDOM OF INFORMATION OFFICER `Z�s,'
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1329 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.
Name Of Owner SHANKS, LEWIS B.
Mailing Address 1 C/O INLAND HOMES INC.
P. O. BOX 117
City St Zip MATTITUCK NY 11952
Property Address 1 OLD SHIPYARD LANE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 64.00 block 2 lot 47.000
Cross Street LANDON LANE
Building Permit Number Cross Reference:
Issue Date: 5/12/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRY % Z Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
' Southold, New York 11971
REGISTRAR OF VITAL STATISTICS y �
® �- *% Fax (516) 765-1823
MARRIAGE OFFICER ` sj' ®I�� Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER ==7®1 �i
OF INFORMATION OFFICER —.,,>iir���' "—_,----
FREEDOM - __ __ _
OFFICE OF THE TOWN CLERK ; ' SAY '
TOWN OF SOUTHOLD 81995
-
TO: Southold Town Building Department t�'�-`�'�e� '� Wit_ If
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: MAY 5, 1995
Transmitted herewith is a copy of application No. 1378 for a Cesspool/
Septic Tank Construction Permit submitted by:
INLAND HOMES INC. FOR LEWIS B. SHANKS •
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.
c
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE
DISAPPROVE /� t9
Comments: p...4%-liffili--efif,g � Z �C A,
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Signatur
3/7_-- 55
Dat
OFFICE' OF THE TOWN CLERK �r
_� •
Town of Southold Application No.��Z
Judith. T. Terry, Town Clerk pp s�
Town Hail, 53095 Main Road Construction
P. 0. Box 1179
Southold, New York 11971 Alteration
Telephone - Residential__.
(516) 765-1801 Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. •
Fee '$
DATE
APPLICANT NAME: Inland Homes Inc.
APPLICANT ADDRESS: P/O Box 117,Mattituck,N.Y. ,1 1952
SEPTIC CESSPOOL /I/
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: Lewis B. Shanks
OWNER MAILING ADDRESS: Use Applicants Address
OWNER PROPERTY ADDRESS: ' Old Shipyard Lane,Southold
TELEPHONE NUMBER OF CONTACT PERSON: 298-9696
TAX MAP NO. : Section64 Block 2 Lot 47
CROSS STREET: 225' N/W of Landon Lane
BUILDING PERMIT NUMBER CROSS REFERENCE:
� . , \ o it
Signature of Applicapt
1111
RECEIVED BY:
//� own Clerk's Office
DATE: ?b/
r~ Jr SUFFOLK CO HEALTH DEPT. APPROVAL
' ' �j i H. S. NO.
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---- - �` - —" STATEMENT OF INTENT
1 , THE WATER SUPPLY AND SEWAGE DISPOSAL
i SYSTEMS FOR THIS RESIDENCE WILL
� �O : r ;..'.1{ :.'
~� CONFORM TO THE STANDARDS OF THE
' SUFFOLK CO DEPT. OF HEALTH SERVICES
(,tel i {_v Ui_S��) L i ✓ j �:�` (51
APPLICANT
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( 1 s , SUFFOLK COUNTY DEPT. OF HEALTH
'`\ / SERVICES - FOR APPROVAL FOR
/ \ ` CONSTRUCTION ONLY
DATE. MAY 01
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---\ I O W.t r y_..-- Pfa0P / SUFFOLK CO TAX MAP DESIGNATION:
�h I—=- - •'-i LAfEfQ •
F27P _ / 1 DIST. SECT. BLOCK PCL.
77,' r}r�. ii.H--'-r ioco 2 47
0=7� _ �+` OWNERS ADDRESS:
-Ln . �;Pr0P [f1 . , 1
o� _-- �� \SEPTIC J �\ v fE i DTr-I�ti.IA IZdr�_�!
n, 2'.in .:)' S.
� � �� _� f �� Niv,`;-�•1-T,..I:..I4, NY i 1795.
f t X6,3 j 5`\.351 4£.f L,
— r.5. -4*Ob, �° 15,0 � 1 0 • •
Z 1 ° SCALE•
Q= ! i DEED• L P.
' 3 1 c - - �- -` i TEST HOLE STAMP
RI' >F,i�EA= I !1250 SQ FT. 1 wrveyisavb eret�rot,
to this violation of
• ,1 i Q < Section 7208 et the New York State
' MON L)Mt��T Education Lam
(rzEs.)
1 - ---- INC,-620104 Copies of this survey map not bearing
�Jj 4 a t�$ LOAM embossethe land d seal seal
not be considered
}- ;� , Fi r----- ——— 1' to be o wend true copy.
-__
iltnhi Guarantees indicated hereon shall run
I • ty to the person for whom the survey
I i
t 91204t/1J . aeeared.and on his behalf to the
�% i SSLTV le Company.govementalagencyand
D Institution listed hereon and
LO.1M fa the easipnees of the lentfnp g
trtion.Guarantees are riot tranSferepM
AMEND A Pf'__i? 19c25 tP edttwnai lnstu'ulons or, quest
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i Lc:. NO5. (2EFE < To MAI=' OF FC�L)Ni:•E1�5 EST 5• Fi'� � , I SEAL
THE SUPE CD,_C!_E J 5 ,�ti=FiCE CS ! i ,-..._ r fi,r.y ;•> ): .,.. PALE eeowti
— MAP' �c0^83 1i � ,,i„6•> ` 'r , Fi N TO s
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GREENPORT NEW YORK I `'
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TELEDYNE POST N81329 ..