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JUDITH T.TERRY IIIC y� Town Hall,53095 Main Road
TOWN CLERK k e) ar 1 P.O.Box 1179
'1 Southold,New York 11971
REGISTRAR OF VITAL STATISTICS Fax(516)765-1823
MARRIAGE OFFICER #411 O� I�,
RECORDS MANAGEMENT OFFICER �.( jig 10.00 Telephone(516)765-1800
FREEDOM OF INFORMATION OFFICER ..."--•,... ,,s•'
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1336 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : MARTIN BANCROFT
Address 1 : P. O. BOX 2060
City St Zip ORIENT NY 11957
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. #R10-95-0057
Name Of Owner BANCROFT, MARTIN
Mailing Address 1 P. O.BOX 2060
City St Zip ORIENT NY 11957
Property Address 1 NARROW RIVER ROAD
City St Zip ORIENT NY 11957
Tax Map No. section 27.00 block 2 lot 2.003
Cross Street PLATT ROAD
Building Permit Number Cross Reference:
Issue Date: 5/19/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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4$1GypJUDITH T. TERRY . F. Town Hall, 53095 Main Road
TOWN CLERK : o T P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS VO ��,` Fax (516) 765-1823
MARRIAGE OFFICER /�� �O lFax
(516) 765-1801
RECORDS MANAGEMENT OFFICER '�'�(/,` 4 it
FREEDOM OF INFORMATION OFFICER = /,////1/
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: May 15, 1995
Transmitted herewith is a copy of application No. 1385 for a Cesspool/
Septic Tank Construction Permit submitted by:
Martin Bancroft •
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. MN 15
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE
DISAPPROVE
Cornments: 0 12c csc /2/72/ i,'iv -�5.---Etej-- '
Signatu
Dated
1
OFFICE OF THE TOWN CLERK ,.""'
. —
Town of Southold .'�� �FFDLK
�J CSG Application Nos.
Judith T. Terry, Town Clerk ,. y'
Town Hall, 53095 Main Road �� 4 = Construction
P. 0. Box 1179 v ,z
1Alteration
Southold, New York 11971
tt� yc
Telephone ,y �Qi $10.00 - Residential
(516) 765-1801Ol * , ' $25.00 - Non-Residential
• -- - _ I,,
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE `t 'JTZ
APPLICANT NAME: KINkKct �� ����0�T
APPLICANT ADDRESS: (p. j . Box 0_0 (00
-A-
SEPTIC X CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: f�-Cit (2)>qNC\OV T
OWNER MAILING ADDRESS: &:1 (3 X QLO
1�t�1`r ) 10cALS
OWNER PROPERTY ADDRESS: ' I\A\(ZRQW *VvtR / LPc1
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section ' Block cP, Lot cZ .3
CROSS STREET: kRpW v�� R
BUILDING PERMIT NUMBER CROSS REFERENCE:
•
40, -4/
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Si. a r- of Ap.lican
RECEIVED ti
RECEIVED BY:
TQ,v�p iI5rI4950ffice
DATE: MAT
Southold Town Clerk
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EXCAVATION INSPECTION ION RE(IIRED t!
9 A. O F
O O
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N. ,,\ �1 �"" � 6�z08? Ir (�0,0/ c 0, O PLEASE NOTE
\oo, \r �/ ..,,,,,-444,.„._ FN°14,, fie,.s S f ''��9 w°1h h°,h Minimum distance between well
2,00 �' ��ry4, �M w. h and cesspool is to be 150 feet.
ass O \ ,e0 So 1v,,4��o ear ,SO
1 e""11%.,______: i
.....„
// 1)7 \ �SSOO \�\ POND S 78 310'E Cr
so/_90 F \ Ca Z SINGLE FAitilLY DWELLNG ONLY E
F o
i.
/ oq�4,Gk);A, \ E 5 EXPIRES THREE YEARS FROM DATE OF APPROVAL g$
/' RF y \ " 30. w POND 111 / SUFFOLK COUNTY 9RART MENT OF HEALTH SERvtC:l
('0�0 8 ' �� \ FOR AP 1OYAL OF O ISTRUCTION ONLY z
o� \ 19j9 •
/ DA 02 MSNM „o„Rla-9 -.1e-570
co APPROVe‘26 J-11 3AA1
w,ENl \ �SSpUp u s.:
L° �a12$S SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES CERTIFICATION
/ ( `5 "I AM FAMILIAR WITH THE STANDARDS FOR APPROVAL AND CONSTRUCTION OF SUBSURFACE
EL�DCco'�S� N 81.02'w. • 9 j SET FORTH THEREIN SYSTEMS
AND ON FOR
SINGLE
PERMFAMILYOCONSTRUCT ES AND HALL ABIDE BY THE CONDITIONS
py
SO.0y EL g., APPLICANT'S SIGNATURE:
APPLICANT:
STREET ADDRESS-
CITY: STATE: ZIP CODE ag
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TELEPHONE NUMBER: `SPI,
s'
SURVEY FOR:
MARTIN J. BANCROFT, JR. P;•--
b i
^-� LOT 3 "SETTLERS AT OYSTERPONDS"
,` - `t-:li
PAt : ORIENT Town of: SOUTHOLD
''''' Suffolk County, New York
NOTE:1 ■ = MONUMENT FOUND NPR 6 tgSS
= STAKE FOUND Suff. Co. Tax Map 1000 027 02 2.3
= STAKE SET vT O17 District Seclio Bloc. Lot
2. SUBDIVISION MAP FILED IN THE OFFICE OF THE �R�?DE ,''LS {��/
7,. ',r cu,rr,^L< COUNTY ON MAY 4, 1fIIR4 ,"�� ri