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® Town Hall, 53095 Main Road
JUDITH T. TERRY ":
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS : Southold, New York 11971
MARRIAGE OFFICER k%'!. Fax (516) 765-1823
4,% �1 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. 868 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X •
PERMIT ISSUED TO:
Name : EAST ISLE CUSTOM BUILDERS INC.
Address 1 : 278 JAMAICA AVENUE
City St Zip MEDFORD NY 11763
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILY DWELLING WITH SANITARY SYSTEM.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES ON 5/14/92.
Name Of Owner RUTHER, JOAN (CONTRACT VENDEE)
Mailing Address 1 (OWNER - ELLA STELZER)
219 THIRD STREET
City St Zip GREENPORT NY 11944
Property Address 1 HORTON AVENUE
City St Zip MATTITUCK NY 11952
Tax Map No. section 141 .00 block 2 lot 7.000
Cross Street SHIRLEY ROAD
Building Permit Number Cross Reference:
Issue Date: 7/20/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRY ‘,4 ' Town Hall, 53095 Main Road
TOWN CLERK ® P.O. Box 1179
REGISTRAR OF VITAL STATISTICS .% Southold, New York 11971
MARRIAGE OFFICER �� ,;�� Fax (516) 765-1823
-6(0) $4 if Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK � '+W
TOWN OF SOUTHOLD ( C tit,E c ti r'-, ,
TO: Southold Town Building Department lito 1 1 JUL 9 /992
LILFROM: Linda J. Cooper, Southold Town Clerk's Office �Ak- . } ,
TOWNns=,.DATED: July 8, 1992 , 3uti
rd
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Transmitted herewith is a copy of application No. 892 for a Cesspool/
Septic Tank Construction Permit submitted by:
East Isle Custom Builders, Inc for Joan Ruther (Contract Vendee) .
Please review the application and location map and advise if the project
has received Suffolk County Health Department approval and if this office
may issue the permit.
Please complete the form below and return it to me.
Thank you.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE X
DISAPPROVE
Comments: a. „4,,,� a 11 Z1APC0, klgC61 -$ 1'
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Signature
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Dated � Z
,
OFFICE OF THE TOWN CLERK
Town of Southold
Judith T. Terry, Town Clerk Application No.W9
Town Hall, 53095 Main Road Construction 1------
P.
P. O. Box 1179
Southold, New York 11971 Alteration
Telephone Residential
' (516) 765-1801 Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
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117, 7'(77:77:777,77-;:E.,=',: i
APPLICATION 'N :
JUL - 71992L
for u u x_, __ _ _ �L..��
CONSTRUCTION or ALTERATION PERM �,.
ITiUb EJf �-- P P J
SEPTIC TANK or CESSPOOL
' Permit No. 'S-q 6-
Fee $ /6
Fee $ ,/6
DATE
APPLICANT NAME: EAST ISLE CUSTOM BUILDERS, INC.
APPLICANT ADDRESS: 278 Jamaica Avenue
Medford, New York 11763
SEPTIC x CESSPOOL x .
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
construction of single family dwelling
•
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: Ella Stelzer, Mattituck
CUNIRACI VENDEE IS: Joan Ruther
OWNER MAILING ADDRESS: 219 Third Street
Greenport, New York 11944
OWNER PROPERTY ADDRESS: S/S Horton Ave, 310.79' E/O Shirley Road
Mattituck
TELEPHONE NUMBER OF CONTACT PERSON: East Isle Custom Builders: 727-6023
. TAX MAP NO. : Section 141 Block 2 Lot 7
CROSS STREET: Shirley Road
BUILDING PERMIT NUMBER CROSS REFz ENCE:
1 At
Signature • ' •plicant
Xit /(
RECEIVED BY:
Town Clerk's Office
DATE: 7- - 9.
,Sc/RVE/EO FoR JOa/✓ ReiTh/ER �ry PLEASE NOTE (5e..T/YIdo. /DOO-/4/-2-7
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PROPER7V /Oc,o7 ..a aT/r47-777-cic•<
IOWA/ OF SoUT/-/oLO __ ILL l�(
It is the applicants responsibility toi
L9JFFOLK COUJvTy /t/EN/yORK _ 7-e5-7" IlioL
/ 1
92 .._ 5(.-, maintain adequate sanitary distar��r�C�e 0RK5' paBROWNSawayloga,y)4REr4-- 1Igi7 0between all water supply ancYw4 e '
Sc4LE /""=3o' • disposal facilities. /39 20 aRoWN`agMrsallo
rl Pate 6vo vn/
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SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES /f�gr \) //' ,4'
•/ �oP. Wl•Ir�) ./f310/5 r 5o - ✓ L • ./ fiNE ro COARSE
FOR APPROVAL OF CONSTRUCTION ONLY �V I - -resT - 1 -0c'--s- f° `--•;i
DATEMAY 11- ;f REF. NO v -1 1I h,, A, 34 4
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APPROVED I i iii —� r \ 7�6°R • `i ��•y
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East Isle CustomBuilders, Inc–A. — Z o /°c % P ,, a 4,� o �° a z 3 _
?_78 Jamaica Ave. �_ 6 s; °- p„_.,�L- �'� z� �F ;m A y, :
Medford, N.Y. 11763 2• 42'O /L�P' _
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Unauthorized alteration or addition to this survey Is a violation a / 8 cr. '
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of Section 7209 of the New York State Education Law. � n oy v,Tc, y �r n,�'et fy '
m `' '� D �pPR Ex,6r \ -PP t<-'14'N''.,
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Copies of this survey map not bearing the Land Surveyor's inked \-,. '( AREA °f scgap ^ `^�� a�r,�”' e��J�:
seal or embossed seal shall not be considered to be a valid true fg p \}` E� l AN1tQR0' b5'''' ¢ t�T� ut;a�
copy - . __ ..._.. — - y 5' , Y R°PJ�us� 5 GV5o1 R) �� ! _`- B.
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Guarantees or certifications ind,ca•ed hereon shall run only to �� N 1r •y1' ,� 75��,� �`� a /00oc, ISNE°
the person for whom the survey is prepared, and on his behalf to ` r 11�-- \
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the title company, governmental agency and lending institution o i �” 5 oo , O" 01
listed hereon, and to the assignees of the lending institution. 0 \' �j 7 / ✓ ,^
Guarantees or certifications are not transferable to additional ___-----
A` �jo v I �GP \
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institutions or subsequent owners. � /� � n r ���� �/ D �{�/:
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CERT/P/ED To: ce , \ Ir a 1l�n/0 F FR,OAIK J,BARyisx/
i0,44/ A72/7,17/E7.? 1 RegiDENCe
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