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'*'1% Town Hall, 53095 Main Road
e1�® ®-es P.O. Box 1179
••06 Southold, New York 11971
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JUDITH T. TERRY �.Wr.tri "Of TELEPHONE
TOWN CLERK (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 476 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : INLAND HOMES, INC.
Address 1 : 315 WESTPHALIA ROAD
City St Zip MATTITUCK NY 11952
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 10/18/88.
Name Of Owner TENEDIOS, PETER
Mailing Address 1 65 BAYRIDGE AVENUE
City St Zip BROOKLYN NY 11220
Property Address 1 HENRY'S LANE
City St Zip PECONIC NY 11958
Tax Map No. section 74.00 block 1 lot 17.000
Cross Street MIDDLE ROAD (RT. 48)
Building Permit Number Cross Reference:
Issue Date: 3/21/89 Judith T. Terry
Southold Town Clerk
(TOWN SFAI 1
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` TOWN OF SOUTHOLD % c°Y 1,N- Town Hall, 53095 Main Road�'�� ,. ��r P.O. Box 1179
-; '470 .4, � IO oi. Southold, New York 11971
JUDITH T.TERRY '= L' #000
�.�„,„o0 TELEPHONE
TOWN CLERK `' (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
To: Victor Lessard, Southold Town Building Department
From: Linda Cooper, Southold Town Clerk's Office
Dated: March 15, 1989
Transmitted herewith is a copy of application No. 486 for a Cesspool/
Septic Tank Construction Permit submitted by: '
Inland Homes, Inc. for Peter Tenedios , •
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.
, �ccs
Linda J. Cooper
* * * * * * ” * * * * * * 1
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE X
DISAPPROVE n
Comments: q,, --K-49.-.L.
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Signature
Dated
OFFICE OF THE TOWN CLERK
Town of Southold Application No. 4� ,r
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road Construction
P. O. Box 1179
Southold, New York 11971 Alteration
Telephone • Residential a/
(516) 765-1001 Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
LT=Si
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 41.7lo
Fee $
DATE March 13, 1989
APPLICANT NAME: TNTANT) H0N S_5. TNC®
APPLICANT ADDRESS: 315 Westphalia Rodd
MattitucX, N. _Y. 11_952_�__
SEPTIC CESSPOOL X
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
New--_ • - :.:: • .. ' g ---
LOCATION MAP; Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: Peter Tenedios
OWNER MAILING ADDRESS: 65 Ba_yridge Avenue
Brooklyn, N. Y. 11220
•
OWNER PROPERTY ADDRESS: Henry' s Lane
Peconic , N. Y.
TELEPHONE NUMBER OF CONTACT PERSON: 298-9696
TAX MAP NO. : Section 74 Block 01 Lot 17
4181
CROSS STREET: Middle Rd. (Cr. ) 48)
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of—pal cantll_
Robert E. Hiltz
RECEIVED .:Y � Inland Homes, Inc.
FownGClerk's 1 ffice
DATE: MAR U L J _ •
mac* • 44,
I 1
€ 24.8 HENRY'S 2s.o LANE
•
�10[� RE4�RIRED . � t
VM1ON 11�SQEt
24.3 S 42° 09' 30" E 110.00' 26.6 SUR VE Y' OF
r ; '� 636.96' LOT ' 6
'it MAP OF
`" 0 JF"" " r6n. PEC ON/C HOMES
3 V FILED OCT. 14, 1964 FILE NO. 4181
o AT PEC ONI C
"' cl TOWN OF SOUTHOLD
. . & 0 ` f' a Q SUFFOLK
COUNTY N. Y.
¢--z` 4a ,„6____—..; ao —.--. ^ W 0 1000 - 74 - 01 - 17 t
i.e.- z -� y J Scale 1g = 30'
° Pr°P ho 's �°
U.
M o PLEASE NOTg ug. 3C, 1988
a' z ---'
�-�, o w Requires septic tank
x rix
N J cover to grade. = '
l N _ , ,
Z p ��
1 �" U z ti
• 1d Prof o SINGLE FAMILY DWELLING ONLY _..„..
�.-� �y=M cc EXPIRES TWO YEARS FROM DATE OF APPROVAL
O The locations of wells and cesspools shown hereon are from field
�\_,./ observations and or from data obtained from others.
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
' FOR APPR VAL OF CONSTRUCTION ONLY
0 gXSO -/3 CERTIFIED TOJ
flb ,iIlzew _
.t�LoPt - DAT HS R . NO_
o� / 5PANA GIO TIS TENEDIOS
1 6 / /----jr9A;7/...--.7. VARVARA TENEDIOS
oi
PROVED (/ ./ j`
h
Prepared In accordance with the minimus /°697 .7
/ ,(� `
ss.s standards For title surveys as established
/ °6 7� �Q LA,li-
by the LLA.LS. and approved and adopted sc,9 SU
-for such use by The New York Stale Land 5 A r��
-0 N 44° 26' 50" W f+K Title Association. �g,�O�,�c'l ' cF
110.09 '
The water supply and sewage dis os al ,+ . ,,,, . �` t N. Y.S. LIC. NO. 4966;
systems for /h residence win conform J $ ~3