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JUDITH T.TERRY Town Hall,53095 Main Road
TOWN CLERK c P.O.Box 1179
O t Southold,New York 11971
REGISTRAR OF VITAL STATISTICS �Q 10 Fax(516)765-1823
MARRIAGE OFFICER � j9V./� Telephone(516)765-1800
RECORDS MANAGEMENT OFFICER I £
FREEDOM OF INFORMATION OFFICER �•,,, ,.���
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1430 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : LYNCH HOMES
Address 1 : 321 COUNTRY ROAD 39-A
City St Zip SOUTHAMPTON NY 11968
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. SCHD REF. #R10-95-0111
Name Of Owner SMITH, RANDY AND DIANE
Mailing Address 1 22445 MAIN ROAD
City St Zip CUTCHOGUE NY 11935
Property Address 1 BRIDGE LANE
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 84.00 block 1 lot 6.011
Cross Street ROUTE 48
Building Permit Number Cross Reference:
Issue Date: 12/20/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY T % Town Hall, 53095 Main Road
TOWN CLERK k , P.O.Box 1179
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'�� Southold,New York 11971
REGISTRARMARRIAGE OFFICER
\ , ®' / Fax(516)765-1823
RECORDS MANAGEMENT OFFICER =-v4 ����I. Telephone(516)765-1800
FREEDOM OF INFORMATION OFFICER ' `` -; ------r
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OFFICE OF THE TOWN CLERK ' L' !j DEC 1 5 1995 1,
TOWN OF SOUTHOLD rs Am���"�
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TO: Southold Town Building Department k_--TC1r a.= :-'�L''"Ma --4
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: December 18, 1995
Transmitted herewith is a copy of application No. 1486 for a Cesspool/
Septic Tank Construction Permit submitted by:
Lynch Homes for Randy and Diane Smith •
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.
- 4(-4/-Ce-ec--
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:ec
APPROVE !/
DISAPPROVE
Comments: f, _ /O- -®
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Signaturey' /
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Dated //
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OFFICE OF THE TOWN CLERK �FFO
Town of Southold ��� - coG Application No./Vrk,
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road 1 Residential
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P. O. Box 1179 (13 Non-Residential
Southold, New -York 11971 o;, �o ��`
Telephone = ( �►
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
MIIIIMXPOWN PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
I r (y° l(r,Y)A-0--a
• 33c=. -( CC,ce,0 �t`� ` DATE / Z. / �S
AS O c e l G`�-4/11 P7 /0 (CSS d n ,�
OWNER NAME: / f L --b/#17t/6—
U/7 �/Na /#7v6—
OWNER MAILING ADDRESS: c.,9 q/5 /4 /-/A)
OWNER PROPERTY ADDRESS : /}j/2( D4 E Li -t)C. e (, rcH04 OC
OWNER TELEPHONE NUMBER: 73C./ - 67(1 /
TAX MAP NO. : Section gq Block / Lot e /1
CROSS STREET:
TYPE OF SYSTEM: Septic Tank .•••=k- New Existing
CesspoolNew Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT:
LOCATION MAP: Must be attached hereto before permit may be issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
,
%moi .,
/ Signature of/ pplicant
RECEIVED BY:
Town I rk's Office
DATE:
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