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JUDITH T. TERRY2CTown Hall, 53095 Main Road
TOWN CLERK O ►Y�
P.O. Box 1179
REGISTRAR OF VITAL STATISTICS - Southold, New York 11971
yt Fax (516) 765-1823
MARRIAGE OFFICER ® r •
=__ .' 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. 970 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
CESSPOOL SYSTEM FOR A SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES ON 3/23/93.
Name Of Owner SIOLAS, PETER
Mailing Address 1 BOX 117
City St Zip MATTITUCK NY 11952
Property Address 1 SUNSET DRIVE
City St Zip MATTITUCK NY 11952
Tax Map No. section 106.00 block 8 lot 50.003
Cross Street DAISY ROAD
Building Permit Number Cross Reference:
Issue Date: 4/15/93 Judith T. Terry
Southold Town Clerk
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JUDITH T. TERRY `� Town Hall, 53095 Main Road
TOWN CLERK ® P.O. Box 1 179
REGISTRAR OF VITAL STATISTICS ; I :1111 W
1 • Southold, New York 11971
MARRIAGE OFFICER / i �®A, ,6 Fax (516) 765-1823
® Nit, 6i Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK ''r. "`:-'� ' '
TOWN OF SOUTHOLD P I 181 E, f ‘
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,''s, MAR 3 01993 ' ` "
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town- Clerk's Office i-;
DATED: March 30, 1993 "s
Transmitted herewith is a copy of application No. q97 for a Cesspool/
Septic Tank Construction Permit submitted by:
Inland Homes Inc. for Peter Siolas
' 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 A
DISAPPROVE
. Comments: q,Q, •�„� ,I✓$j Si.. o 0o.c au.t
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Signature
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Dated
OFFICE OF THE TOWN CLERK
Town of Southold
q7_
Judith T. Terry, Town Clerk Application No '
Town Hall, 53095 Main Road Construction
P. 0. Box 1179 Alteration
Southold, New York 11971
Telephone Residential
(516) 765-1001 Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
•
'7q7
Permit No.
Fee $ /0
DATE__ 25/93 --
APPLICANT NAME: Inland" Homes The.
APPLICANT ADDRESS:_515 Westphalia Rd.�
Box 117 Kattii k_
SEPTIC CESSPOOL -4i
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
1 Family Dwelling
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: Peter Siolas
OWNER MAILING ADDRESS: Box 117 Mattituck
OWNER PROPERTY ADDRESS: Sunk Drive Mattituck
TELEPHONE NUMBER OF CONTACT PERSON:___Agow515_298,9696 ---
TAX MAP NO. : Section 106 Block R Lot
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CROSS STREET: Daisy_ Road _____��•____�_�__ ___
BUILDING PERMIT NUMBER CROSS REFERENCE:
AO
Signature of Applica 1111116..
RECEIVED BY:
Town Clerk's Office —
DATE:
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SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES SURVEY FOR
PETER SIOLAS 81 GEORGIA SIOLAS DEC 14,1992
DEC. 2,1992
•
FOR APPROVAL OF CONSTRUCTION OF AT MATTITUCK DATE: SEPT
5,1999 2
Single Family Residence OnlyOCT.
DAT =: 1''S S ; . 1 a. API” TOWN OF SOUTHOLD SCALE: I" = 100'
SUFFOLK COUNTY, NEW YORK 1 ; NO. 85-1354
•
APPROVED A N uNAUTNORIz[D ALTERATION OR ADDITION-TO THIS GUARANTEED TO'
SURVEY D A VIOLATION OF SECTION 7209 OF THE , PETER a GEORGIA SIOLAS
EXPIRES.3 YEARS FROM D E OF•APPROVAL NEW YORK STATE EDUCATION LAW SOUTHOLD SAVINGS BANK
*COPIES Cf THIS SURVEY NOT BEARING THE LAND' COMMONWEALTH LAND TITLE INSURANCE
R'S INKED SEAL OR EMBOSSED SEAL SHALL
NOT BE EKED TO BEA VALID TRUE COPY CO. (NO. H530569S)
'
N GUARANTEES INDICATED HEREON SHALL RUN ONLY?10
HEALTH DEPARTMENT-DATA FOR APPROWL TO CONSTRUCT TRE PERSON FOR WHOM THE SURVEY IS PREPARED I •
AND ON HIS BEHALF TO THE TITLE COMPANY,GOVERN- IS°6
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*NEAREST WATER ElAIN MI.2 MSOURC€OF WATEII.M111NTE..ft IC_ MENTAL AGENCY AND LENDING INSTITUTION LISTED '`�C0 SWF CO.TAS MAP DIST��SECTION..1M—BLOCK31*-LOTP S HEREON,AND TO THE ASSIGNEES OF THE LENDING*THERE ARE NO DWELLINGS WITHIN 100 FEET OF THIS'PROPERTY CSTAI�ITIOONIIALUINSTITUTIIONASORNSUTSENOFERABLE W. j� •.
OTHER THAN THOSE SHOWN HEREON. I ,'
MEW
THE WATER SUPPLY AND SAGE DISPOSAL SYSTEM FOR THIS RESIDENCE
OWNERS `Z•. /;y'4""'WILL CONFORM TO THE STANOAROS OF THE f11►FOLK COUNTY DEPARTMENT *DISTANCES SHOWN HEREON FROM PROPERTY LINES * !�� •' • .1'
.•.' TOEKISTINB STRUCTURES ARE FOR A SPECIFIC , .L", Li.-i
ARUCAMT+ 1 PAND ARE NOT TO SBE USED TO ESTABLISH 1, F} /
OF HEALTH SERVICES.
PROPERTY LINES OR FOR THE ERECTION OF FENCES h
ADDRESS I
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