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JUDITH T. TERRY :: ,
Town Hall, 53095 Main Road
TOWN CLERK ® P.O. Box 1179
REGISTRAR OF VITAL STATISTICS r C Southold, New York 11971
MARRIAGE OFFICER ®' .�1 Fax (516) 765-1823
1\ 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. 843 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : GERALD AND LINDA WEIR
Address 1 : 2917 EASTERN BLVD.
City St Zip BALDWIN NY 11510
Descripton of Proposed Construction or Alteration
NEW SINGEL FAMILY DWELLING WITH SANITARY SYSTEM.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES ON 4/17/92.
Name Of Owner WEIR, GERALD AND LINDA
Mailing Address 1 2917 EASTERN BLVD.
City St Zip BALDWIN NY 11510
Property Address 1 2223 INDIAN NECK RLANE
City St Zip PECONIC NY 11958
Tax Map No. section 86.00 block 5 lot 11 .003
Cross Street LESLIE'S ROAD
Building Permit Number Cross Reference:
Issue Date: 5/28/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRY �� � r t JA s 3/
TOWN CLERK `, c70 FYI f'V L ...,,,,. 01Tp/ r 01f4 r;,„,,P.O. Box511Main Road
REGISTRAR OF VITAL STATISTICS H qP §otith„o1d,New York 11971
MARRIAGE OFFICERe O -�* Fax 7516) 765-1823
T*__74 ��®.�!� Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK' ,==T---
TOWN OF SOUTHOLDry'
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To: Southold Town Code Enforcement Officer h_.
From: Linda Cooper, Southold Town Clerk's Office$ °tri! .
Dated: _ MAY 7, 1992
Transmitted herewith is a copy of application No. 865 for a Cesspool/
Septic Tank Construction Permit submitted by:
GERALD AND LINDA WEIR .
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.
4t_ C_Gee___-
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited abb4
and make the following recommendations: 4+9),s� ►®
P
APPROVE D� Yjj ' 70,
DISAPPROVE �i���•v ,
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Comments: o� ciN, ..V SI'SZ4-0-1A2-1cl.s._
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Signature
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Dated
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OFFICE OF THE TOWN CLERK c.0FO( `,'
Town of Southold .N, �� Application No. F4 S^
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road .° ,f ,,., Construction
P. O. Box 1179 v
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Southold, New York 11971
Alteration
Telephone '1:°./ r 1t, 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. (R•-(7
Fee $ /
DATE 6/6,/?,Z
APPLICANT NAME: ((.0LA-3��
APPLICANT ADDRESS: 7-917 t✓a,S-j-e-v n 4 ( .
gc, I w IAJ I t.S l y
SEPTIC "/ CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
fl -'r- -1-tur Si one., ` aM�I cLoe.tl i n
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED., CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: C,e_d � (eL, (,�€� � �. (teltu,4„, LJ
OWNER MAILING ADDRESS: 2-511 Gas-1-eYA ( v�
awlL� (t q It S to
OWNER PROPERTY ADDRESS:__�__-).:aCl "Mk e n tti
c P
0-,d'v1/4„._1C, " k
TELEPHONE NUMBER OF CONTACT PERSON: SH, alq, (ec o
TAX MAP NO. : Section D Block 5 Lot ( (. 3
CROSS STREET: 51A n I,)0-c-
BUILDING PERMIT NUMBER CROSS REFERENCE:.
jae"df.
Signature of Applicant
RECEIVED BY :
Town Clerk's Office
DATE: x/7/9
-..-----6•13-1:5_,- , J SUFFOLK CO.HEALTH DEPT.APPROVAL
_ . ��� �s MSP OF P20P`R[[Y H.s. No.
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,�N. ` Sli2VEYE0 Fors o
\ ' 2,5.... - l I r Approved In ner riu %tit an 10! i Inv
? AL_D LI C J D/7\ 'EI IZ 4p: - tiL15 R.O.W . 2t. , tt�stgattnndriRsd .�.......,.
TO INDIAN N\ 's, 'S'>, \
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NEC/‹.LA. O� `� ECOIr STATEMENT OF INTENT
396f"1-1wELL_, • THE WATER SUPPLY AND SEWAGE DISPOSAL
___-`90 � 1' )11" T';'•,/,/i.( OP SOUT:_t,:,( NY.
SYSTEMS FOR THIS RESIDENCE WILL
CONFORM TO HE STANDA DS OF THE
\8 ' \ \\ /\• ,� SUFFOLK C EPT TH RVICES
'6 ,� / '''J� - . & SINGLE _. ' _': „ �,..,P t..t�Yr e`..1t..{ IS) - ,��/
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�. yO F j EXPIRES TWO Y ARS FROM DATE OF APPROVAL APPLICANT
��' �L ,/ SUFFOLK COUNTY DEPT OF HEALTH '
' \ ' �� \qi �L=¢ �' N v T SERVICES - FOR APPROVAL FOR
`�O\o \r 0 5 `MF �C��O CONSTRU Off!ONLY
p 1 85 0. ' 4''. s� 'VSIC/ DATE p` " 4 7 19Z
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3 11 �?`oqf �^1/4 ,kz SUFFOLK CO.TAX MAP DESIGNATION
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tOWNERS ADDRESS:
N I 1 I5 I I or1qry 1\ c91Z E 45TE2t.i LLYD.
aN , , I. '0 4. -O �O� °I e W t3ALDWIN, N.Y. 11510
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NOTES: - 1 7 , �'u.�� VJATEf� �T�` w L.ati�ov�
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,� _ LICENSED LAND SURVEYORS C�_---
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' .TITLE NO. G 2-S-23 0 -- --- • GREENPORT• ' NEW YORK
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