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ELIZABETH A. NEVILLE �� Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS 140 `
Southold, New York 11971
MARRIAGE OFFICER `� � Fax Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER =__ ®1 w' ir®iii Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER `. • ��
OFFICE OF THE TOWN CLERK
SOUTHOLD /TTR@SAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 26117 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : INLAND HOMES INC
Address 1 : PO BOX 117
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. REF #
Name Of Owner INLAND HOMES INC
Mailing Address 1 PO BOX 117
City St Zip MATTITUCK NY 11952
Property Address 1 PEQUASH AVENUE
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 110.00 block 3 lot 31 .000
Cross Street MIDWOOD ROAD
Building Permit Number Cross Reference:
Issue Date: 8/28/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE too 4,s I �� Town Hall, 53095 Main Road
TOWN CLERK % "- % P.O. Box 1179
REGISTRAR OF VITAL STATISTICS 1 "" - i Southold, New York 11971
MARRIAGE OFFICER
�`" ������� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER =__W®A/ ,,ss22,, tot Fax
(631) 765-1800
FREEDOM OF INFORMATION OFFICER -'--e-„,,..i''
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: August 24, 2001
Transmitted herewith is a copy of application No. 2736 for a Cesspool/Septic Tank Construction
Permit submitted by:
Inland Homes
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.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments: `/ �1= _
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Signature
19/4/ as
Dated
O1`FICE OF THE TOWN CLERK ,i''CAFFOlkcO . a 7 Jto
TOWN OF SOUTHOLD ;� G Application No.
ELIZABETH A.NEVILI F,TOWN CLERK 0
P.O.BOX 1179 : . :142m; Construction V
SOUTHOLD,NEW YORK 11971 c=3 IT
Alteration
Telephone �Q��i� $10.00 - Residential
(516) 765-1801 l *� •0'� $25.00 -Non--Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee '$
DATE 8/24/01
APPLICANT NAME: Inland Homes
APPLICANT ADDRESS: PO Box 117,Mattituck,N.Y. . 11.952
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
New single family dwelling
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: Inland Homes
OWNER MAILING ADDRESS: PO Box 117,Mattituck,NY , 11952
OWNER PROPERTY ADDRESS: Pequash Ave,Cutchouge
TELEPHONE NUMBER OF CONTACT PERSON: 298 9696
TAX MAP NO. : Section 110 Block 03 Lot 31
CROSS STREET: Midwood rd.
BUILDING PERMIT NUMBER CROSS REFERENC. : •ending
'� dkir 1►
Signature of Applicant
10, CFIIVED
RECEIVED BY: ft
own Clerk' Pfe4 2QU1
DATE: Ciwrk
t "` , =. EST HOLE DATA
PERFORMED BY McDONALD GEOSCIENCE
15 AUGUST, 2000
• , S EXISTING GRADE /J a �'
3 BROWN LOAMY SAND SM /v SURVEY OF
BROWN FINE TO COARSE SAND SW
6'PALE BROWN FINE SAND SP DESCRIBED PROPERTY
8'PALE BROWN FINE TO COARSE SAND SW SITUATE
9.8' 7I / /
WATER IN PALE BROWN FINE TO COARSE SAND SW J CV TCHOGUE, TOWN OF SOUTHOLD
10' _
1BWATER IN BROWN CLAYEY SAND SC MID WOOD RD- SUFFOLK COUNTY, N. Y.
WATER IN PALE BROWN FINE TO MEDIUM SAND SP RESIDENCE
24' o SURVEYED FOR INLAND HOMES, INC.
gp WE I L O /2:
w N/F KAVANAGH �CESSPOOL RESIDENCE GFS / ZONED R-40
FOR S.C.D.H.S USE ONLY \_i ,0 ( -, CESSPOOL \I 75 2 9, /\a�� SURVEYED 04 APRIL, 2001
LOT 8
FM 3683 '�
FILED NOV. 16, 1962 SO„ 1-\\
SLATE SCALE 1"=30'
54 0 25 PLANTINGS BY OTHERS GM 2
_ ' _ / 10 Z AREA= 16,624.72 SF
. 22' PROPOSED\ O . ,..---...\
J� OR
DRIVEWAY TESOO 0.352 ACRES
CESSPOOL O \15 e GARAGE (JHOLE\ `�
ELEVATIONS TAKEN FROM EAST END
` 1 \ PROPOSEDSWATER SERV �� TOPO MAPS FILED IN S C.D.P.W., YAPHANK, NY
`j
PROPOSED '`mss. o� W
po CESSPOOL 65'
N/F ANDREWS BEDROOM PFcOPOSE 3/ \/`—'—
RESIDENCE SEPTIC O rr ^^ WELL s� RESIDENCE
RE ENCS TANK -PROPOSED O v J -
CESSPOOLS PROP. MUM WATER SVC.
0 Q
O " \ PR P ; i GUARANTEES INDICATED HERE ON SHALL RUN
OSED ONLY TO THE PERSON FOR WHOM THE SURVEY
20 IS PREPARED, AND ON HIS BEHALF TO THE
\ 0% EXPAN OAI I I �{
/"--'. � 1-� 1 N � �/ ,. TITLE COMPANY, GOVERNMENTAL AGENCY,
CM 1 I ' Lii LENDING INSTITUTION, IF LISTED HEREON, AND
�,+ \ 50`/ �— �1 TO THE ASSIGNEES OF THE LENDING INSTITUTION.
(/� ' I ( GUARANTEES ARE NOT TRANSFERABLE TO
F In 2B 10 FD ADDITIONAL INSTITUTIONS OR SUBSEQUENT OWNERS.
N/F CORWIN �`
RESIDENCE I CM q ' h----
UNAUTHORIZED ALTERATION OR ADDITION TO THIS
S 57' 42' 00" �/�/ l 75. 00 SURVEY IS A VIOLATION OF SECTION 7209 OF
7\
Q/ �� THE NEW YORK STATE EDUCATION LAW.
`' \ N/F BOCCIA ,,� � s
��5 RESIDENCE p o,
COPIES OF THIS SURVEY MAP NOT BEARING
SHALLW
RESIDENCE NOT BEND CONSIDERED TO BEOASVALIDSURVES EMDAL TRUE
L 0 T 9 (^10- THE W PROP MUN. WATER SVC. COPY.
FM 3683L
FILED NOV. 16, 1962 f s
SURVEYED BY
F. F. EL. 17.0 MIN.
STANLEY J. ISAKSEN, JR.
FINISHED GRADE EL. 13 P.O. BOX 294
TM 1000-110-03-31 INV. EL. /1.2_ "7 INV EL.II.O - NEW SUFFOLK, NY 119,/
INV. EL. 12/
631 . 73�—58 5 / 1,
_
INV. EL. l/.7 n t� / j/ ��.�/'�
GUARANTEED TO II LICE %D LANDR DR
3' MIN. GROUND WA TER EL. 0.3
INLAND HOMES, INC
r- NYS I, C. NO. 49' 73
SEPTIC TANK
I ADD WATER MAIN 6 PROP. HOUSE CONNECTIONS /OMAY01 CESSPOOL O1 C999
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