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Home My WebLink AboutFredrikkson, Jim & Elaine o��OF SOUlyol ELIZABETH A.NEVILLE Town Hall, 53095 Main Road TOWN CLERK P.O. Box 1179 REGISTRAR OF VITAL STATISTICS N Southold, New York 11971 MARRIAGE OFFICER �� Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER Ol�' Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER C out, southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 3601 R Residential X Non-Residential Fee $ 10.00 Septic X Cesspool PERMIT ISSUED TO: Name : COASTLINE CESSPOOL Address 1: 4225 BRIDGE LANE City St Zip CUTCHOGUE NY 11935 Descripton of Proposed Construction or Alteration -REPLACE OLD BRICK SEPTIC TANK AND BLOCK OVERFLOW POOL WITH PRECAST -MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS,BUILDINGS,PROPERTY F LINES AND WATER BODIES. EXCAVATION INSPECTION REQUIRED. Name Of Owner JIM & ELAINE FREDRIKKSON ------------------------------ Mailing Address 1 195 YOUNGS AVENUE ------------------------------ ------------------------------ City St Zip SOUTHOLD NY 11971 -------------------- -- ---------- Property Address 1 195 YOUNGS AVENUE ------------------------------ ------------------------------ City St Zip SOUTHOLD NY 11971 -------------------- -- ---------- Tax Map No. section 61.00 block 4 lot 3.810 ------ --- ------ Cross Street MECHANIC STREET ------------------------------ Building Permit Number Cross Reference: ---------------------------------- Issue Date: 11/15/07 Elizabeth A. Neville -------- Southold Town Clerk (TOWN SEAL) r OF SOU��® ELIZABETH A.NEVILLE �® �® Town Hall, 53095 Main Road TOWN CLERK 1��! l�t P.O. Box 1179 REGISTRAR OF VITAL STATISTICS Southold,New York 11971 MARRIAGE OFFICER ® �� Fax(631) 765-6145 RECORDS MANAGEMENT O FICER l Telephone (631) 765-1800 FREEDOM OF_INFORNIA-JIO FFICER yCOM 1 I southoldtown.northfork.net c ` _ V1 J,__ 4 7 OFFICE OF THE TOWN CLERK E TOWN OF SOUTHOLD So h d Town Building Department FROM: Lynda M. Bohn, Southold Town Clerk's Office DATED: October 31, 2007 Transmitted herewith is a copy of application No. 3760 for a Cesspool/Septic Tank ALTERATION Permit submitted by: Coastline Cesspool for Fredrikkson 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. Lynda M Bohn I have reviewed the application and location map of the project cited above and make the following recommendations: APPROVE V DISAPPROVE Comments: Maintain required setbacks from adjacent wells, buildings property lines and water Bodies. EXCAVATION INSPECTION REQUIRED. Signature // M Dated O ELIZABETH A.NEVILLE h`Z` Gy Town Hall, 53095 Main Road TOWN CLERK p P.O. Box 1179 h Z Southold, New York 11971 REGISTRAR OF VITAL STATISTICS Al MARRIAGE OFFICER Gy �� Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER �f 0 Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER �'� �a southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANK Residential @ $10 v" or Non-Residential @$25 Application N6 ) Permit No. � Applicant Name C U Applicant Mailing Address Septic Tank ✓ or Cesspool Brief Description of Proposed Construction or Alteration mo-(-A r (. dd \0\ocl, '-e C ask. Location of Proposed Construction/Alteration: Owner of Property: Owner Mailing Address: Owner Property Address: Name and phone number of contact person C c- osA-\, - lt>1C.o-q O3- Tax Map No: Section Block Lot _a;� , Cross Street � . NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL ( 11_�=1_1tiA K_ \O\ Signature of Applicant Date Received by: SURVEY OF PROPERTY 51TUATE:50UTHOLD ° TOM 5OUTHOLD i e � 5UFFOL-K COUNTY, W w � %\ SURVEYED 08-26-03 AMENDED OG-24-03 ) _ SUFFOLK COUNTY TAX # - 1000-61-4-38.1 CERT TO: .Jim.Freddksson&Elaine Fredn'ksson Commonwealth Land Title Insurance Company The Chase 1Mfanhattan bank 0 Of 96 ice" Lz o yyq S P" offe 91 / 'g,N '3)O 60i o I eGL G ® �Aov69�0 1 Of � a O\O 13�o f NEW�o d �lyJ(" � �.w'a,u�crNed arzaraucn or odmu�,tc a wrvey mop Nclatbn tUtl—off licensed lord wrverycr s seol b o aecNon � � �` � stompe•dcnsyoo:'vepMieus N�acrnamcYc(c2tnnrGskab9ocafrrethdo tmoiICoMtro uwvu St..Edc 'ocsryidsovuLfyrowvcew re§oy• ��®OS ,1O' 34.29' ccpias' NOTES: ® Gertifkatlang dcated hereon sg ify WL hs vey m prepo ed b Occvrda a nIN b ex- t 'KtYig Lcae ci Proctor-for LOM-.treys odvptad L t1b Nen York$tato AssocbLkr vi Profe55bnal .�> �•`� �� tv LLn pp eon rcr�li+Livm rNe crvay ss pirepored• ■ MONUMENT FOUND Verna Land Now or Fo \ a d on his beMlF o t s title compo y governmen- r l ®��CJ tot agency era lendng�r�suwtbn weed hereon rnn to the ossv�es aF Na IeMv�g Lrstitutgn GerNikO- qq tone or t troreteroble N odd:[cmi nsGWtbrr� TITLE No. RH80031G4q itzpatri�� WiIg r P Lt JOHN �:° ES LAND SURVEYOR EY®R AREA = 14,615 5F or 0.34 AGRES y 6 EAST MAIN STREET N.Y.S.LIC.NO.50202 GRAPHIC, 5GALE 1"= 20' RIVERHEAD,N.Y. 11901 369-8288 Fax 369-8287 REF.\\Hp server\d\PROS\03-243.pro i