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JUDITH T. TERRY • Town Hall, 53095 Main Road
TOWN CLERK ® T ..' P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS = �® �� Fax (516) 765-1823
MARRIAGE OFFICER ' s,� • ��� Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER ®1 •t
FREEDOM OF INFORMATION OFFICER ���i
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1128 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : WINDS WAY BUILDING CORP.
Address 1 : 1020 GLEN ROAD
City St Zip SOUTHOLD NY 11971
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.
Name Of Owner WINDS WAY BUILDING CORP.
Mailing Address 1 1020 GLEN ROAD
City St Zip SOUTHOLD NY 11971
Property Address 1 R.O.W. OFF NEW SUFFOLK AVENUE
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 116.00 block 2 lot 1 .004
Cross Street NEW SUFFOLK AVENUE
Building Permit Number Cross Reference:
Issue Date: 5/11/94 Judith T. Terry
Southold Town Clerk
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JUDITH T. TERRY a Town Hall, 53095 Main Road
TOWN CLERK ti ® ,, P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS Fax:` Fax (516) 765-1823
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER =_, ���' Telephone (516) 765-1801
FREEDOM OF INFORMATION OFFICER ��,...,,,por#•'
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
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TO: Southold Town Building Department _ L :r 4 l
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FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: May 3, 1994
TOWN SOLD J
Transmitted herewith is a copy of application No. 1167 for a Cesspool/
Septic Tank Construction Permit submitted by:
Winds Way Building Corp .
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.
u.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE L/
DISAPPROVE
.7
Comments: Se / de / zYLA -" ' /
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REC .% ./'
Signature(-CRR /
MAY ' -0 1994 - �
Town Clerk Sof: ord Dated
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OFFICt OF THE TOWN CLERK , �
,,'",,,,,"'-
Town of Southold 0'1 fair ''
� Application No. li tQ 7
Judith T. Terry, Town Clerk ,' y\ /r
Town Hall, 53095 Main Road ; t Construction ✓
•
P. O. Box 1179C. rn
Southold, New York 11971 •
•
y . �••�• Alteration
Tele hone O �0��• $10.00 - Residential
P
(516) 765-1801 =��1 � '' $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. -� -
Fee
DATE S
'b/q41
APPLICANT NAME: �(1� W eali7-0 c q110 .
APPLICANT ADDRESS: 10 a-o 6 (I5-0
)Lvlo, rv(i it iDi
SEPTIC r/ CESSPOOL V f
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
c9T c� .1;40 — r1�c,� r ��, r;GJ to
LOCATION MAP: Must be attached hereto before permit may be issued.
•
LOCATION OF PROPOSED CONS RUCTION OR ALTERATION:
OWNER OF PROPERTY: i IJ EtS OkIrcl (~
OWNER MAILING ADDRESS: 10 C . Cftot: 40.9i1 lir) )
OWNER PROPERTY ADDRESS: / /1III/ (L , !
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section /16 Block 6 / Lot 1, 4-
CROSS
4-
CROSS STREET: Alij Sc l4., y 4,‘• 5 t(1
BUILDING PERMIT NUMBER CROSS REFERENCE:
i
hi// Signature of Applicant
RECEIVED BY: /D` '
Tow/ Clerk's 0 e
DATE: 5— -8-9/
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ATE op Apprics,AL ,
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OTE H.S. NO.„___,,,
1 .' Sariitatysyster�is not to be ' • - �., _�� ' ,-�-"``' EXPIRES 11e FAY Dti•J pp�y ;
;t 1 i ;"i-' tptac:ed under driveway area. ':r THREE YEARS FRAEI p
.zo, .: :,' ." L.. ' . ..., "., . ' ,-' re-
...^-,Gp \ :� /' 4 `� h die fi r� STATEMENT OF INTENT-, / /. / • .-- . .- •
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THE WATER SUPPLY AND SEWAGE DISPOSAL
SYSTEMS FOR THIS RESIDENCE WILL
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Fr`l'/ / t , / �` o CONFOR,u /Fd T�c1 S OF THE
,-( J / `CZ' SUFFOLK CO T "ST DA�i�.
- _ / 1- . - 5 A�_ TH/�ERVICES.
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/ �_ BUI!_DIN(y` Ido G/Id+ tia• 0 .101111,hi /�sl
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d /' Qi / W I / / SUFFOLK CO.TAX MAP 0 ' 10'^ATIOH.
3''1 CONTOUI REFER TJ •, / Q
a• Q I ' e SEAN SFA LEVEL b /` ` A �/ !I) I DIST. SECT. BLOCK PCL.
1. / /04 (fie °g
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I 3 stn v f I /` / OWNERS ADDRESS'
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;4, MAP OF PROPERTY \ /��b Lla
SURVEYED F02 �r \ -SAND
.MAP-AMENDED-DEC•12,1989; SEAL
/IK. D5 1A./AY BUILDING CORP MA2GFI 1,1993 >ai�C 121 3'
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