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JUDITH T. TERRY � O Town Hall, 53095 Main Road
TOWN CLERK p Fr s P.O. Box 1179
REGISTRAR OF VITAL STATISTICS � Southold, New York 11971
MARRIAGE OFFICER Q O�' •�� Fax (516) 765-1823
'NW � Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 996 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : RIVERSIDE HOMES, INC.
Address 1 : P. O. BOX 274
City St Zip RIVERHEAD NY 11901
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES.
Name Of Owner YOUNG, EDITH
Mailing Address 1 C/O RIVERSIDE HOMES, INC.
P. O. BOX 274
City St Zip RIVERHEAD NY 11901
Property Address 1 HORTON AVENUE
City St Zip MATTITUCK NY 11952
Tax Map No. section 141 .00 block 2 lot 9.000
Cross Street SHIRLEY ROAD
Building Permit Number Cross Reference:
Issue Date: 5/13/93 Judith T. Terry
Southold Town Clerk
(TOWN S�A1,1
S �® - �4 MAY t 193
JUDITH T. TERRY ' S e g Dr Tis vri Ia111, 53095 Main Road
TOWN CLERK TOWN CA SOUTHOLD P.O. Box 1179
® T r� r... . .'',',:':a
REGISTRAR OF VITAL STATISTICS I� �` S'ouihol'd, New York 11971
MARRIAGE OFFICER czW'
,� Fax (516) 765-1823
" /� Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: May 7, 1993
Transmitted herewith is a copy of application No. 1024 for a Cesspool/
Septic Tank Construction Permit submitted by:
Riverside Homes, Inc. for Edith M. Young
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 X -
DISAPPROVE
Comments:
Signature
Dated
.),
+FFICE OF THE TOWN CLERK
Town of Southold
Judith, T. Terry, Town Clerk Application No./L'
Town Hall, 53095 Main Road Construction v
P.
0. Box 1179
Southold, New York 11971 Alteration
Telephone Residential
° (516) 765-1801 Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
•
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOLPg. 107771,1
' MAY 71993
No. �L' �',, `,Y
Permit ._�•.�,. - - -_.-_- '; .
Fee $
DATE
APPLICANT NAME: RTVFRSTDF HoMFS, TNr_
APPLICANT ADDRESS: PO Box 274, Ri'vPrhPacL 11Pw York 11901
SEPTIC x CESSPOOL x
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
construction of single family dwelling
LOCATION MAP: Must be attached hereto before permit rri'ay be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: Edith M. Young
OWNER MAILING ADDRESS: c/o Riverside Homes, Inc. , PO Box 274,
Riverhead, New York 11901
OWNER PROPERTY ADDRESS: sec Horton Ave and Shirley Rd, Mattituck
TELEPHONE NUMBER OF CONTACT PERSON: 727-3395
TAX MAP NO. : Section 141 Block 2 Lot 9
CROSS STREET: Shirley Rd
BUILDING PERMIT NUMBER CROSS REFERE '4CE: j
RIVE'S r AOS r S, II
:at. , .A
i s i at re of Appli ant
S. Gurdon President
•
RECEIVED BY:
Town Clerk s Office
DATE: RECEIVO
MAY 71�+�s
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ELEVATIONS ARE REFERENCED t
TO AN ASSUMED DATUM. The locations of wells and cesspools a.
shown hereon are from field observations ►I a"
and or from data obtained from others.