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OFFICE OF THE TOWN CLERK cOFOLA-e,
Town of Southold - ~w
Judith T. Terry, Town Clerk �,; .''L^�
Town Hall, 53095 Main Roadc=3N ti: �
P. O. Box 1179 .c-r3 4 '-* si _
Southold, New York 11971 O ' VTw4,y3 O� �
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Telephone- - 01
(516) 765-1801 •
TOWN OF _SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
•
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 291 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool X
PERMIT ISSUED TO:
NAME: Edgar and Donya VanBuren
ADDRESS: 8 Columbus Avenue
Smithtown, New York 11787
DESCRIPTION OF PROPOSED CONSTRUCTION or ALTERATION
New Single Family Dwelling 'With Cesspool System
APPROVED as approved by Suffolk County Health Department on 9/15/86.
LOCATION OF PROPOSED CONSTRUCTION or ALTERATION:
OWNER OF PROPERTY: Edgar and Donya VanBuren
OWNER MAILING ADDRESS: 8 Columbus Avenue
Smithtown, New York 11787
OWNER PROPERTY ADDRESS : Bay Avenue
Cutchoque, New York
TAX MAP NO. : Section 104 Block 4 Lot p/o 33
CROSS STREET: Lilac Lane
BUILDING PERMIT NUMBER CROSS REFERENCE:
• gormeworomarso-
Judith T. T y
Southold Town Clerk
DATE : FEbruary 29, 1988
(TOWN SEAL)
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,; E` i ;r' -_ '...:2:‘ 1 Town Hall, 53095 Main Road
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Southold, New York 11971
JUDITH T.TERRY L' TELEPHONE
_ - I OWN CLERK �� +} r (516) 765-1801
RLGISTRA,R of vlr 1L s rn rlsrles OFFICE OF THE TOWN CLERK -
TOWN OF SOUTHOLD -
• February 29, 1988
Edgar and Donya VanBuren .
8 Columbus Avenue
Smithtown, New York 11787
Re: Bay Avenue
• CCitchogue, New York
•
Dear Mr. and Mrs. VanBuren:
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
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,
41643.44r,i
Judith T. Terry
Southold Town Clerk
Enclosures (3) _ -
JTT/Ijc
_sr_ .JJI If
sem` I�
"r,`'n`•' AA'
` Town Hall, 53095 Main Road
Na �►�� P.O. Box 728
;rJ y f Southold, New York 11971
JUDITH T TERRY TELEPHONE
TowN CLERK (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
February 11, 1988
To: Victor Lessard, Southold Town Building Department
From: Judith T. Terry, Southold Town Clerk
Transmitted herewith is a copy of application No. 295 for a
CONSTRUCTION or ALTERATION Permit for a cesspool or septic system
submitted by Edgar & Donya VanBuren •
Please review the application and location map and advise if the
project has received Suffolk County Health Department approval
and if we may issue the permit.
Please complete the form below and return it to my office.
Thank you.
Judith T. Terry
Southold Town Clerk
* * * * * * * * *
I have reviewed the application and location map of the project
cited above and make the following recommendation:
APPROVE -
DISAPPROVE -
COMMENTS:
Signature
Date
OFFICE OF THE TOWN CLERK FU(,�
Town of Southold � „nw CSG
Judith T. Terry, Town Clerk kat. -E.,;;.,:,-4:^ : Application No. �
Town Hall, 53095 Main Road rye j Construction
P. 0. Box 1179 tn
Southold, New York 11971 40 rs, . 1 Alteration
Telephone _ 1 4( , 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 February 11 , 1988
APPLICANT NAME: Edgar & Donya VanBuren
APPLICANT ADDRESS: 8 Columbus _Avenue
Smithtown, New York 11787
SEPTIC Y` CESSPOOL-" X _ =
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
Story & half, 1800 square feet single family dwelling
LOCATION MAP: Must be attached hereto before permit may be issued.
• LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: Edgar & Donya VanBuren
OWNER MAILING ADDRESS: 8 Columbus Avenue
Smithtown, New York 11787
OWNER PROPERTY ADDRESS: Bay Avenue , Cutchogue
TELEPHONE NUMBER OF CONTACT PERSON: 265-0339 (home ) 369-7735 (work)
TAX MAP NO. : Section 104 Block 4 Lot P/0 33
CROSS STREET : Lilac Lane (private road not built)
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of Applicant
RECEIVED BY: E �
/ Town C erk's Of ice
DATE: c 1•Xc �f
- - - - -- ---- --- -- - - - -- --- -- -- - - - - - - - - -- --- ----- ---- -------------------------
•
- _ , _ - -
SUFFOLK CO HEALTH DEPT APPROVAL
r {� "The Iocatio f.:-..e. w --._ __. . I_.___� J._'i t
,•, ns o, wale/ ,pr�ly and/ot
c =t .have sewage disposal facilities c1:;IEb
property
ih been verified.
y
_ STATEMENT OF INTENT
SY ; :' \ THE WATER SUPPLY AND SEWAGE DISPOSAL
•„5 U ` ----/ - -- -- - --- - +-------- - ------- - _-- __ .___-__ SYSTEMS FOR THIS RESIDENCE WILL
r : c •.• \'J _ -- CONFORM TO THE STANDARDS OF THE
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SUFFOLK CO DEPT OF HEALTH SERVICES
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tI CJ fl (\J . ,..)-4.' . L APPLICANT
/ SUFFOLK COUNTY DEPT OF HEALTH
:, I " " , SERVICES - FOR APPROVAL OF
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4- -- CONSTRUCTION ONLY
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a _ c..+ ; The locations o. the water supply anBlor i• (�
�'• - - I " -d sewage disposal facilities on this property (O I I H S REF NO �(1 &.....„...,
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a]a N ' 7 I ..' SUFFOLK MAPNAT
BLOCK CO TAX DESIGNATION
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DIST SECT LOC PCL
c., i PLEASE NOTE J�> +,,<I. I,?-_
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j i�c1 It is the a[� licant's responsibility to / -` • .
11 maintain a ,c,�+ate sanitary distance -
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`•ry; I • ) disposal facts;ties. //
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GREENPORT NEW YORK
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