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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK ® P.O. Box 1179
1$' ,� Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER '` ®�'Vii, Fax (516) 765 1823
RECORDS MANAGEMENT OFFICER ?/®1 °A�1°�� Telephone (516) 765 1801
FREEDOM OF INFORMATION OFFICER r
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1131 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : VINCENT URWAND
Address 1 : P. O. BOX 323
City St Zip NEW SUFFOLK NY 11956
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. # R10-94-0025
Name Of Owner URWAND, VINCENT
Mailing Address 1 P. O. BOX 323
City St Zip NEW SUFFOLK NY 11956
Property Address 1 EVERGREEN DRIVE
(LOT 9)
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 102.00 block 1 lot 4.009
Cross Street DEPOT LANE
Building Permit Number Cross Reference:
Issue Date: 5/24/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
1/3.401Cty
JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
�' Fax (516) 765-1823
MARRIAGE OFFICER ' ej" � Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER ®1 14 Il
FREEDOM OF INFORMATION OFFICER �� ��rjoll
OFFICE OF THE TOWN CLERK Li 18 L Lti
TOWN OF SOUTHOLD si ;Gl
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TO: Southold Town Building Department
TOWN
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: May 9, 1994
Transmitted herewith is a copy of application No. 1170 for a Cesspool/
Septic Tank Construction Permit submitted by:
Vincent Urwand - •
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 s�
DISAPPROVE•s
Comments: $2%4 / 467-7c—o 07
Signature
Dated
S
AFFICE OF THE TOWN CLERK cjVFFQCI('C+�
JudithTT. Terry, Town Clerk own of Southold ,k( �M Application No. 112
Town Hall 53095 Main Road
• � � z=•' � �14 Construction �
P. O. Box 1179 -:. "r J
Southold, New York 11971 Alteration
Telephone _ 1 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 g - 9y
APPLICANT NAME: 44,11-„A ��104()A-A�
APPLICANT ADDRESS: Sp 't) l' cie,9,/,/c (p® fox 3
Ai 643 (rafr:04i< y
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
//U(9L4- ,lf4tl1-1 Ly �� I- /A/Zy-
LOCATION MAP: Must be attached hereto before permit may be issued.
• LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: V/A/C, 7— ,2",0/4-A➢D
OWNER MAILING ADDRESS: /dQ gox 22 3
`of_(k) scf�-�o4-/e_ nl__Y I/9,4
OWNER PROPERTY ADDRESS: GGi 46- P z."-
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section / 0 -2., Block 0 ( Lot 171,
CROSS STREET: L,
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of Applic nt
RECEIVED BY:/--Yer
Town Clerk's Office
DATE:
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SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES 0 i
FOR APPROVAL OF CONSTRUCTION ONLY
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DATE= 23 ' HS.REF.NO.oirle,- 99/-00.45— iss ov-
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APPROVED
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,t The water supply and sewage disposal \ /I
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systems for this residence will conform
ILI to the standards of The Suffolk County \\y .
-i Department of Health Services. • \ % .
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TOTAL AREA = 97,802 sq.ft.
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SURVEY. OF •
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"THE WOODS AT CUTCHOGUE" , ' " . • -'':,. -:,:
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PECBIEVEC FLED MARCH 24798 9 AS MAP NQ 8717 , '" ' ' ..
AT CUTCHOGUE
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