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' = x ,° Town Hall, 53095 Main Road
°- -C - Vii`` P.O. Box 1179
__-Ni Cv. �� "1 Southold, New York 11971
JUDITH T.TERRY = '�`��I FAX(516)765-1823
TOWN CLERK TELEPHONE(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. 473 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : HARBOR CONTRUCTION OF S. I. INC
Address 1 : P. O. BOX 457
City St Zip SHELTER ISLAND NY 11964
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILY DWELLING WITH SEPTIC SYSTEM.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES.
Name Of Owner SANBORN, GEORGE
Mailing Address 1 160 WEST 87TH STREET, APT. 2A
City St Zip NEW YORK NY 10024
Property Address 1 OLD FARM ROAD
City St Zip ORIENT NY 11957
Tax Map No. section 26.00 block 4 lot 5.000
/
Cross Street ORCHARD STREET
Building Permit Number Cross Reference:
Issue Date: 3/10/89 Judith T. Terry
Southold Town Clerk
(Tr1WPJ 'FAI 1
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f _,10_, s`,'.S ' '. Town Hall, 53095 Main Road
BLDG DEPT. ' ��� 4�` P.O. Box 1179
-_. T (y OF SOUTHOLD 1, . y ,-t�
`�� �'� . i+ Southold New York 11971
y+,�" 'i g�/I TELEPHONE'
JUDITH T.TERRY
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: March 7; 1989
Transmitted herewith is a copy of application No. 483 for a Cesspool/
Septic Tank Construction Permit submitted by: '
Harbor Construction of S. I . Inc. for George Sanborn .
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 recom endations:
APPROVE X
DISAPPROVE
Comments: cd„0 ,.a..,c .e..c _,g.. SA.,..i, Q.o-Raa ) v cQw... -La
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Signature
Dated
OFFICE OF THE TOWN CLERK �OrjlF.�rC��
Town of Southold Off_.,,; .k Application No.
Judith T. Terry, Town Clerk r 4ti , �,�'p.i.�
Town Hall, 53095 Main Road Fs
fat-li
"S ' Construction
P. O. Box 1179 .cti• =. Alteration
Southold, New York 11971
'761l Yp Residential X
Telephone
(516) 765-1801 Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. t,I 213
Fee $ / O , 0-6
DATE g41?-0-1)
APPLICANT NAME: Aoltry2a251/21j4.71‘
/f (P �, imje
APPLICANT ADDRESS: eZC7)C '5/67 //
S In e- 1-4-ea. -6 / -/` /U //944/
SEPTIC CESSPOOL /
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION �'cT-'a2.6,70T
61 rL JSP -�t�w�,i � alb e /z7 T-7//
s,<7,m ,S
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION�`' ORALTERATION:
OWNER OF PROPERTY: Ne_, C �-,y4-4DoCT1U -
OWNER MAILING ADDR' ;: /6D 0401- 874S-6eal /Or/ a�
_,Oeu) 1J.`� /oc a /
OWNER PROPERTY ADDRESS: XS-4R/ 07I tp��yyl d�-dACf/
TELEPHONE NUMBER OF CONTACT PERSON: (5/6) 7tI9,d33a() 3- 1, Ab
TAX MAP NO. : Section ca6) Block O'q' Lot
CROSS STREET : fA,g,ZC/ ��/?c e27
',BUILDING PERMIT NUMBER CROSS REFERENCE:
Si nature of Appl ant
RECEIVED BY :
Town Clerk's Office
DATE:
•
. •( VACANT)" ' -- . ( VAGANT) • • . • - -hf
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LDFV3� ADa,S: RO -�„
,r,: 222 :1:8 z /29 _ . „, �: . '14-3 N $S°:25• 00• E' - ,
✓ ELECTRO , = • - 74;49 `,
TELEPNON� , `
- 80X ' -•TRANSf'ORMEft 1 _
►VELA 7/5•x: - - .
. ' _ • - -``r! _ •
��': I LOT
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U) • CP.•OVER ISO
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D���qG w EL4 a =
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' LOT 13e �:: 1 s ' . �`. ;
.\:. -.,i)-4:.;,-, -----\---:. -. _ . ,
x_ ' (DWELLING - - �
,e . . t, ` gdSteM. -
;aWELL 8 •CP: LOCA : _ _ c -
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ID
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R'S t VE r OF
, .% , _
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K�N�s �,o ���G SUBDIVISION MAP OF
p -4� . -1-DAY FARM" ' _. -
M '
, FILED JUNE 19,-•1982- FILE NO. 7045
,r ' AT :ORIENT
�; �;: . TOWN. OF SOUTHOLD . = - =
, ' -, A.9._� �. ; •
�. _'AREA s i. 3 ACRES " .. -- SUFFOLK COUNTY, N. Y. . , . r ,
:p•c p y ' - ' -100'0' --- 26 0:4.- - 05 '
Scale . I,,: 40,' _ ` : ,
a
Jan. 3'1, 1989-
' ; _ FEB, 24, 19891REVISE)
'1,''' ' SUFFOLK COUNTY 'DEPARTMENT OF HEALTH SERVICES, '
. ' FOR 'APPROVAL .OF•CONSTRUCTION ONLY- _ •
- DATE p HS REF.'N0. = .•s
.APPROVED -
_ - , ; ' Tho locations.of-wells and cesspools-shown-hereon are Irom,field•
'- s
r observations and or,from,dat_a obtained from others. - = .1-)141440 ,
ELEVATION -ARE'REFERENCED TO �+ IA. /Nc G9�; _' .r} - -'ASSUMED,`DATUM ' - O� FEZ�'• -
- 'the`wale,supply and of wails•diiposaJ - � t s
r .siIteitwfor this r eldenoe-wl!r''oonform :r, • , -- N. .S; ',LIC. NO:' 49868,
- -,:alba`-st taside of Tito Suffolk County - 11��i\
rDePirtmenri'o f,,HsiiltJi:Skrlos Prepared in ackfil mio.r wlth the,mlNmiine . P•..........
v�%S _p C, '
s:' standarde v -tllJe'
for su%veys.i'eaitablieliod•, -. ,.. "� 0 • ,_.
�. ,• - b the LJ.A.L:S.--aind``pproved attd addpt d. � , _ •
_ _ ' • - for inch•use'by The New York,Stati-Latnd•- . : : •, P"•`0 -.LXMa v '- - . - -t, - _ •,t , .
. , ,. _ _ Title Association: ,. MAIN'_ s' � -
:, . _ , . SOUTHOLD, N Y ..11971"