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JUDITH T. TERRY z Z Town Hall, 53095 Main Road
TOWN CLERK p T P.O. Box 1179
REGISTRAR OF VITAL STATISTICS tl') Southold, New York 11971
MARRIAGE OFFICERyQ I Fax (516) 765-1823
746,, WO''' � 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. 989 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : J. M. EBERHARDT
Address 1 : P. O. BOX 143
City St Zip EAST MARION NY 11939
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES ON 4/16/93.
Name Of Owner EBERHARDT, J. M.
Mailing Address 1 P. O. BOX 143
City St Zip EAST MARION NY 11939
Property Address 1 THREE WATERS WAY
City St Zip ORIENT NY 11957
Tax Map No. section 15.00 block 6 lot 29.000
Cross Street PARK VIEW LANE
Building Permit Number Cross Reference:
Issue Date: 5/11/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRY ; • Town Hall, 53095 Main Road
TOWN CLERK T•
s,_ P.O. Box 1179
REGISTRAR OF VITAL STATISTICS tri �� Southold, New York 11971
MARRIAGE OFFICER
‘VAI. O�' o'
rr , Fax (516) 765-1823
1 + �� 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: April 26, 1993
Transmitted herewith is a copy of application No. 1015 for a Cesspool/
Septic Tank Construction Permit submitted by:
J. M. Eberhardt .
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:
itiCaND
APPROVE NAY
71993
DISAPPROVE7111ri:1/4 aft,
Comments: (�
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Signature
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Dated
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OFFICE OF THE TOWN CLERK r0(,{w^ 0
Town of Southold
Judith T. Terry, Town Clerk �;"r� �;; � Application No.
Town Hall, 53095 Main Road c j�ti: ' _` � 5
P. O. Box 1179 f1' 13� Construction
�
Southold, New York 11971 � i =�` Alteration
• '�;� ti
Telephone ift � 1 Residential
(516) 765- 1301 n
Non-Residential
TOWN OF SOUTHOLD
•
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
•
APPLICATION
•
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
•
r.
Permit No.
Fee $
2 -3 //.." •
APPLICANT NAME: \ ac-%rl•(#0/,n 7• •
APPLICANT ADDRESS: 4� o�'
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. /-4 ,04,-.„.) v
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
a / -
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: \/, /7, e---674:74 6'.'14
• OWNER MAILING ADDRESS: /9 ° o,E-
OWNER PROPERTY ADDRESS:
TMJZ <- 64-1.0 '‘-c.-4 .f;
TELEPHONE NUMBER OF CONTACT PERSON: 2'7-2�ff/
TAX MAP NO. : Section /s- Block
Lot 2 ?
CROSS STREET: " 01?-/i (//,71.4., ,�,�,✓�— •
BUILDING PERMIT NUMBER CROSS REFERENCE: .
•
•' SIgrlatUl.L, of Applicant pplicant
RECEIVED
Town lerk's ffice
DATE: 7C/9
•
"t'• "'� !— '• SUFFOLK CO.HEALTH DEPT.APPROVAL {
i
• H.S. NO.
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d�.. N. SINGLE FAMILY DWELLi G ONLY •
M f EXPIRES 3 YEARS FROM DAT' " E• 1
HO. a Sca/e: 4O�_/., APPrmeiminNM�nlat�d ....,. ..�_ ._ .. .,
2 NT
Yp' i f (Vpc.c9tlf) b /9 eed: JZQ25 Si:ft. THE WATER SUPPLY AND SEWAGE DISPOSAL
I�1 G !. SYSTEMS FOR THIS RESIDENCE WILL
al r CONFORM TO THE STANDARDS OF THE
�'S '� • ~ ,, Ct33�oa/ t'p)
f t-_ I; SUFFOLK C ' _- H�. I'- SERVICES.
0 z wall Oa) (S) ( i(a�l
J.88'57'�/O•'Pi - jtZ8.64 X90 O,Z. j/ PLICANT
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!fl I • /b SUFFOLK COUNTY DEPT. OF HEALTH
p t• p t l SERVICES - FOR APPROVAL FOR
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.35• _ Q. "I. 5:---- 70= +r . DAT
3 Fa \;n prop'd ;m' G /�
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r.; `cP r ' !�I". • r
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1`. septic! I SUFFOLK CO.TAX MAP DESIGNATION.
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'� . ��„ n I DIST. SECT. BLOCK PCL.
` 1 O drive \�; `� p /000 t5 6 Z9
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OWNERS ADDRESS: y gr�y4rq ^
Z C (4:0÷.�\5c7 expri., O a lUt,IEQTTQCOVENANi��11ES1I111CTIQq! / POrk. vie Lane
IR p LtsE 3Z5
ru. p ��. •ti .�l.38'S7 -f 0"W. - !.'.9.85 i • PA� .. 4Pie'1 N. Y: /1957
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MAP OP Lor No. 6 • 972 z
ho. o I' } rel. 32 -97 7
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021E NT- CJ I- H5- SEA. DEED: L. P.
.' I 51 I SECTION ONE TEST HOLE STAMP
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ikVa,.c i) t._
_ -.- - -- (St/Ftocrc CounrrY FicEo MAP .ala,2777)
OQ,EN7 N. Y.
SUKVEYEO cat
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JOHN -B HA62DT" tsee
Fr/ed
i-- .ti 1oA)
I Ar+rorrded Oct. 28, 1992
PNCIEIVE11) SEAL
OCT 29
C+licvs yed Jct. 26 ./99Z
S.C. DEPT. pF RODE�RICK VAN TUYL.P.C.
HEALTH SERVICES f`'• U.... "r"",.e K -
LICENSED LAND SURVEYORS
j GREENPORT NEW YORK
Iv.nv,t•S%7 NS,1S