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® Town Hall, 53095 Main Road
crs P.O. Box 1179
.1.'t Southold, New York 11971
JUDITH T.TERRY -.__®1 I` to TELEPHONE
TOWN CLERK viii/ (516) 765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 436 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : SAGE, JAMES P.
Address 1 : SAGE, BEVERLY A.
City St Zip GREENPORT NY 11944
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILY DWELLING WITH CESSPOOL SYSTEM.
APPROVED AS SHOWN ON SUBMITTED SKETCH AND AS APPROVED BY THE SUFFOLK
COUNTY DEPARTMENT OF HEALTH SERVICES 5/10/88.
Name Of Owner SAGE, JAMES AND BEVERLY
Mailing Address 1 519 STERLING PLACE
City St Zip GREENPORT NY 11944
Property Address 1 WESTWOOD LANE
City St Zip GREENPORT NY 11944
Tax Map No. section 33.00 block 2 lot 5.000
Cross Street SOUND AVENUE
Building Permit Number Cross Reference:
Issue Date: 12/08/88 Judith T. Terry
Southold Town Clerk
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e BLOCS. DEPT. }� �- �� P.O. Box 1179
"rOyV OF �OUTF6OLp, ‘11/;`,4'
_ 'AV,' Southold New York 11971
JUDITH T.TERRY i�►��
=�..,,,ii�i TELEPHONE
TOWN CLERK (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
To: Victor Lessard, Southold Town Building Department
From: Linda Cooper, Southold Town Clerk's Office
Dated: December 6, 1988
Transmitted herewith is a copy of application No. 443 for a Cesspool/
Septic Tank Construction Permit submitted by:
James P. Sage and Beverly A. Sage
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, _.,,,I .c.„7'e Pa ir,n_ `o,eft,S._ Z iCttc.A c .
Nra7,4 .9-mA % D . 46.,6)":-- Q0-. h., E,I0 \ 1,53 .
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Signature
Dated
OFFICE OF THE TOWN CLERK cvFFO(,r
Town of Southold4 /
Judith T. Terry, Town Clerk ' Application No. /f 4
Town Hall, 53095 Main Road = fit Construction
P. 0. Box 1179 �y { Wtr3 ��` *" J
Southold, New York 11971 ® �l, ! Alteration
Telephone
[ �.a0 Residential
(516) 765-1801 Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $ /0
DATE 4/0
APPLICANT NAME: Jy)(5 p . C1 iF 650e(iLyAPPLICANT ADDRESS: 5/7 Suez/// /G
662F�e� ? 6C, ft). //?'4/L/
SEPTIC CESSPOOL
DESC IPTION OF PROPOSED� CONSTRUCTION, OR ALTERATION
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: F Et/i /_y f-
OWNER MAILING ADDRESS: 5l j � V1 ,�CE_
`q f£��c.2 i f ALC-
OWNER
te. COWNER PROPERTY ADDRESS: kry--7- 7-3 jEs7(,uac o Lm iF
66awipo , IJ,'
TELEPHONE NUMBER OF CONTACT PERSON: 676 — 477
TAX MAP NO. : Section-Q3 jQ Block 00- , Lei Lot 0
CROSS STREET: , C'6//iJli) /(j/
BUILDING PERMIT NUMBER CROSS REFERENCE:
—
eu
Signature--ofi'. . i cant
RECEIVED BY:
Town Clerk's Office
DATE:
I
ti. - , _ SUFFOLK CO.HEALTH DEPT.APPROVAL , \
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tkj
_- I STATEMENT OF INTENT
to " ` /`r�'� I k , MAP OF• !PROPERTY- _ THE WATER SUPPLY AND SEWAGE DISPOSAL
�n Q \? I SYSTEMS FOR THIS RESIDENCE WILL
\- i� - -V r .jr'/�i f/�_= .1--..,:::--4.(_.) C/ '
CONFORM TO THE STANDARDS OF THE
I ' +U I^ / Q 'f_
`` I I `I I CJr4MEs /•PA/az, tC V RLY'' ,`- SUFFOLK CO DEPT OF HEALTH SERVICES.
.. ttl �-�-/ �-...Jr�'1:� I • - ISI
�_ tl 4-7- E rrVL1 t A T APPLICANT
• n ,T,f` ^ / `/ SUFFOLK COUNTY DEPT OF HEALTH
�I I G��E/uF��FT, y r SERVICES - FOR APPROVAL OF
/ e--•'I �� t,3 - U CONSTRUCTION ON
•
L. :'�r ' ter / i.>,. it-. -.r-+• ..uk 4, •:' U \' j DATE ONLY
10\1988
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S1�1Gf_E Fl. 1LY����{'����� ONLY'
� H S REF NO gt�s/ - 6
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c v ( 3 �LGI/C_ -'/-() ° /" , SUFFOLK CO TAX MAP DESIGNATION
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