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OFFICE OF THE TOWN CLERK ��FFO(Kl,
Town of Southold �� Ol/
Judith T. Teary, Town Clerk
cfg
Town Hall, 53095 Main Road x
P. O. Box 1179 - .cr3 ;; x` z
Southold, New York 11971 O
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Telephone 21 ` NN
(516) 765-1801 '
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 304 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool X
PERMIT ISSUED TO:
NAME: Bruce Urban
ADDRESS: P.O. Box 613
Greenport, New York 11944
DESCRIPTION OF PROPOSED CONSTRUCTION or ALTERATION
New Single Family Dwelling with Cesspool System.
APPROVED as indicated on Suffolk County Health Department survey.
LOCATION OF PROPOSED CONSTRUCTION or ALTERATION:
OWNER OF PROPERTY: Bruce and Bonnie Urban
OWNER MAILING ADDRESS: P.O. Box 613
Greenport, New York 11944
OWNER PROPERTY ADDRESS : - Mulford Court, Grand View Estates
Orient, New York 11957
TAX MAP NO. : Section 14 Block 2 Lot 3.24
CROSS STREET: Grand View Drive
BUILDING PERMIT` NUMBER CROSS REFERENCE:
Judah T. T1ry
Southold Town Clerk
DATE : March 15, 1988
(TOWN SEAL)
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Town Hall, 53095 Main Road
tr) {}r= ` �` � P.O. Box 1179
Southold, New York 11971
JUDITH T.TERRY �= : ,r`f rt TELEPHONE
1OWN CLERK (516) 765-1801
RL(ISTRAR 01 VIT 1L S fATISTICS OFFICE OF THE TOWN CLERK
•
TOWN OF SOUTHOLD
March 15, 1988
Bruce Urban •
,P.O. Box -613
Greenport, New York 11944 -
Re: Mulford Court, Grand View Estates
-Orient, New York 11957
Dear Mr. Urban:
Enclosed herewith is the Construction, 'Alteration or Modification
Permit for a Septic Tank or Cesspool System for which you applied.,
Please be. advised that each owner of real property operating an
on-site sewage disposal system, such as a septic tank or cesspool must,
prior to such operation, possess in the name of the owner an Operation
Permit for the system. The Operation Permit is issued by the Town
Clerk's Office.
The fee for an Operation Permit is ten dollars ($10. 00) for
residential use and twenty-five dollars ($25.00) for non-residential. _
Please have the owner complete the enclosed Application for an Operation
Permit and return it to this office along With the proper fee.
For your general information I have enclosed an Informational Y:
Bulletin regarding the Scavenger Waste Laws adopted by the Southold
Town Board. Should you have any questions pertaining to either permits
or the Scavenger Waste Laws, please do not hesitate to contact this
office. We will be glad to assist you in any way possible.
Very truly Yours,
Judith T. Terry
Southold Town Clerk
Enclosures (3)
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OFFICE OF THE TOWN CLERK •c�vFFOCk
Town of Southold �� C�lj
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Judith T. Terry, Town Clerk +� �Iy.�„j . 7 U y Application No.� � �
Town Hall, 53095 Main Road Construction
P. 0. Box 1179 (11 ," g"
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Southold, New York 11971 sya �\-e Alteration
Telephone Ol ��; Residential c%
(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 $ [b
_{
DATE ✓ ��, �i��
APPLICANT NAME: („,
APPLICANT ADDRESS: /so)c, 4 /3
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SEPTIC 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: z!- ,f1(/(7 ( G�0/31 /E6 L-1/(61/41A1
OWNER MAILING ADDRESS: Aoir'
OWNER PROPERTY ADDRESS: „4-1/4//4,-(' C/oz/��- r ��/
11vnii- /Li?(
TELEPHONE NUMBER OF CONTACT PERSON: 9/77 -{9 OO -
TAX MAP NO. : Section (2/ 1 Block o2 Lot 7-,02
CROSS STREET: (--;ThAldv (/J' die 1
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of Applicant
RECEIVED BY:9( -
Town CI k's Office -
DATE: , Q -
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fNE POST N81329 1
' % I I SUFFOLK CO HEALTH DEPT APPROVAL
• ... H S NO
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STATEMENT OF INTENT
�� THE WATER SUPPLY AND SEWAGE DISPOSAL
J ..-•..�. '-,�` i _ _ SYSTEMS FOR THIS RESIDENCE WILL
- _• — CONFORM TO THE STANDARDS OF THE
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SUFFO CO. D / J HEALTH SERVICES.
__.—___..___. APPLICANT
SUFFOLK COUNTY DEPT OF HEALTH
SERVICES — FOR APPROVAL OF
V
CONSTRUCTION ONLY
i1 DATE: c APR 1 7 maiI! \i H. S. REF. NO . 1 11C 3
. i APPROVED � v�
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SUFFOLK CO TAX MAP DESIG ATION- I
DIST. SECT • BLOCK PCL.
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OWNERS ADDRESS- •
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DEED:
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TEST HOLE
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STAMP
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to the gammas of the I+:or.,n 1 tmay-
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SEAL
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j-` ` - RODERICK VAN,T_U_YL. P C. — r r
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LICENSED LAND SURVEYORS 2SF`'LgND`'J�
``: GREENPORT NEW YORK
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