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OFFICE OF THE TOWN CLERK c.0FO(K`,"
Town of Southold - *4 .
Judith T. Terry, Town Clerk r r ti.
Town Hall, 53095 Main Road z, z
P. O. Box 1179 to
Southold, New York 11971 •�,,
Telephone ! 44 $ „,
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 74 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool X
PERMIT ISSUED TO:
NAME: Inland Homes, Inc.
ADDRESS: P.O. Box 117
Mattituck, New York 11952
DESCRIPTION OF PROPOSED CONSTRUCTION or ALTERATION
Single Family Dwelling
LOCATION OF PROPOSED CONSTRUCTION or ALTERATION:
OWNER OF PROPERTY: Andrew T. Stamboulidis
OWNER MAILING ADDRESS: 167-04 14th Road
'Beechurst, New York 11357
OWNER PROPERTY ADDRESS: Green Hill Lane
Greenport, New York 11944
TAX MAP NO. : Section 33 Block 3 Lot 1
CROSS STREET: Sound Drive
BUILDING PERMIT NUMBER CROSS REFERENCE: Pending
•
Judith T. Teri
Southold Town Clerk
DATE: November 17, 1986
(TOWN SEAL)
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JUDITII T TERRY '#4'iii SO TELEPHONE
Town CLI'RK (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
November-17, 1986
Inland Homes, Inc.
Box 117.
Mattituck, New YOrk 11952
Re: Andrew T. Stamboulidis
Green Hill Lane •
Greenport, New York
Enclosed herewith is the Construction, Alteration or Modification
Permit fora Septic Tank or Cesspool System for which you applied.
Please be advised that each owner of real property operating an
on-site sewage disposal system, such as a septic tank or cesspool must,
prior to such operation, possess in the name of the owner an Operation
Permit for the system. The Operation Permit is issued by the Town
Clerk's Office.
The fee for an Operation Permit is ten dollars ($10.00) for
residential use and twenty-five dollars ($25. 00) for non-residential.
Please have the owner complete the enclosed Application for an Operation
Permit and return it to this office along with the proper fee.
For your general information I have enclosed an Informational
Bulletin regarding the Scavenger Waste Laws adopted by the Southold
Town Board. Should you have any questions pertaining to either permits
or the Scavenger Waste Laws, please do not hesitate to contact this
office. We will be glad to assist you in any way possible.
Very truly Yours,
030044:71..../. 1....099.447.---..
Judith T. Terry
Southold Town Clerk
Enclosures (3)
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O�,t. •, ,, A5 4 Town Hall, 53095 Main Road
1. p�' 0 P.O. Box 728
f 1` ' �' Southold, New York 11971
JUDITH T TERRY TELEPHONE
TOWN CLERK (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
November 5, 1986
To: Victor Lessard, Southold Town Building Department
From: Judith T. Terry, Southold Town Clerk ,
Transmitted herewith is a copy of application No. 74 for a
CONSTRUCTION or ALTERATION Permit for a cesspool or septic system
submitted by Inland Homes, Inc. for Andrew T. Stamboulidis
Please review the application and location map and advise if the
project has received Suffolk County Health Department approval
and if we may issue the permit.
Please complete the form below and 'return it to my office.
Thank you.
Judith T. Terry
Southold Town Clerk
* * * * * * * * *
• I have reviewed the application and location map of the project
cited above and make the following recommendation:
APPROVE - '(
DISAPPROVE -
COMMENTS: — fel eJ-1 uJoa. aelu.4.4,v0t1 Gir...4-0-at_
RECIRWD 86 - so - 176
NOV 13S1
Town Clerk SmuthW
Yatik4 C54:4x4L4-647___
Signature
W 431 ,124A1.61,4. / 4 l984
Date
OFFICE OF THE TOWN CLERK
Town of Southold / `
Judith T. Terry, Town Clerk Application No. �`7
Town Hall, 53095 Main Road Construction v
P. O. Box 1179
Southold, New York 11971 Alteration
• Residential
Telephone
(516) 765-1801 Non-Residential -
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $ 10.00 •
DATE November 5, 1986
APPLICANT NAME: INLAND HONES, INC. -
APPLICANT ADDRESS: Box 117, Mattituck, New York 11952
SEPTIC CESSPOOL XX
DESCRIPTION OF`PROPOSED CONSTRUCTION OR ALTERATION
cif, 0 A �
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: Andrew T. Stamboulidis
OWNER MAILING ADDRESS: 167-04 14th Road
Beechurst, New York 11357
OWNER PROPERTY ADDRESS: Green Hill Lane,
Greenport, N. Y. 11944
TELEPHONE NUMBER OF CONTACT PERSON: 765-5402
TAX MAP NO. : Section 1000-03313Iock 03-01 Lot 135
CROSS STREET: Sound Drive
BUILDING PERMIT NUMBER CROSS REFERENCE:
Robert}EnaHiletz;IANNW We , NC.
RECEIVED BY:
Town Clerk's Office —
DATE:
(dwelling)
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CERTIFIED T-0 : ( vacant ) AUG 19 1986. N
ANDREW T. STAMBEULIDIS
EXCAVATION III s , i' of
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The water supply & sewage disposal mr
sys• ®®
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s for this residence will conform Ito the
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standards of the Suffolk Co ty i part- tt
mkn3 al Service ►� MAP OF SECTION FIVE EASTERN SHORES
FILED DEC . 31 , 1968 FILE NO. 5234
'\J' ,,,_,/ / I , ( AT GREENPORT
' J. --''.AND TOWN OF SOUTHOLD
�p� ,�G�G SUFFOLK COUNTY , N . Y.
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* . AUG . 7 , 1986
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1..... " NEWS
Prepared in accordance with the minimum
P E C O N ICf' U R V E Y O R S a ENGINEERS , P. C . standards for title surveys as established by
.( 5 16 ) 76 5 - 50 2 0 the L.I.A.L.S. and approved and ado ted
t P.O. B 0 X 909 . for such use by The New York State Land
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M A I N ROA 0 Title Association.
SOUTHOLD , N Y. 11971 • ,•
86 - 461