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HomeMy WebLinkAboutBoergesson, Kevin I ,ow, . ... JUDITH T.TERRY �,1 yl` Town Hall, 53095 Main Road TOWN CLERK % o % P.O. Box 1179 � Southold, New York 11971 �` REGISTRAR OF VITAL STATISTICS 0y s..*".0 , Fax (516) 765-1823 1 MARRIAGE OFFICER aO �1 RECORDS MANAGEMENT OFFICER 491 * -is'. Fax (516) 765-1800 FREEDOM OF INFORMATION OFFICER �5 ,,, 0"' OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 1442 R Residential X Non-Residential Fee $ 10.00 Septic X Cesspool PERMIT ISSUED TO: Name : KEVIN BOERCESSON Address 1 : P. O. BOX 855 City St Zip SOUTHOLD NY 11971 Descripton of Proposed Construction or Alteration SANITARY SYSTEM FOR NEW SINGLE FAMILY DWELLING. APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES. SCHD REF. #R10-95-0119 Name Of Owner BOERGESSON, KEVIN AND KAREN Mailing Address 1 P. O. BOX 855 City St Zip SOUTHOLD NY 11971 Property Address 1 ROW OFF TERRY COURT City St Zip SOUTHOLD NY 11971 Tax Map No. section 69.00 block 3 lot 6.003 Cross Street GLOVER STREET Building Permit Number Cross Reference: Issue Date: 3/01/96 Judith T. Terry Southold Town Clerk (TOWN SEAL) „,........,...... /Y`'' :-) oilii OF FOL ,:- JUDITH T.TERRY o % Town Hall, 53095 Main Road TOWN CLERK t v) Z 4 P.O. Box 1179 REGISTRAR OF VITAL STATISTICS *. V O # Southold,New York 11971 MARRIAGE OFFICER �yifl 0. 1 Fax(516)765-1823 RECORDS MANAGEMENT OFFICER 49.( iii -0,0' Telephone(516)765-1800 FREEDOM OF INFORMATION OFFICER ..... �i” OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TO: Southold Town Building Department FROM: Linda J. Cooper, Southold Town Clerk's Office DATED: February 20, 1996 Transmitted herewith is a copy of application No. 1499 for a Cesspool/ Septic Tank Construction Permit submitted by: Kevin Boergesson . 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. 1 Linda J. Cooper * * * * * * * * * * * * I have reviewed the application and location map of the project cited above and make the following recommendations: APPROVE C/ DISAPPROVE Comments: J4r Jy3 'ler (S-C/76 /e/C'—2ks - O /77 x , .< �.K ignatur / Date '"• i . OFFICE OF THE TOWN CLERK ,of • Town of Southold ��''��\VOLi'e. : Judith T. Terry, Town Clerk 1'� o� --, OG Application No. l Lf Town Hall, 53095 Main Road �� ' �` •'� : Construction ✓ P. O. Box 1179 i X` 2c • rn i Southold, New York 11971 •c:, .• $ Alteration Telephone ` 0 , .. QC.0 $10.00 - Residential `� (516) 765-1801 1 4 �,, ' $25.00 - Non-Residential TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for CONSTRUCTION or ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. Fee .$ DATE c91 ^q6 APPLICANT NAME: R"e tI1,A --?©ec es , j V APPLICANT ADDRESS: YD, &$. qs. S solo (6, A) V116i7f SEPTIC 1 CESSPOOLX / DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION A!ti(Ai S (Ail Ie Fay, 11. LOCATION MAP: Must be attached hereto before permit may be issued. LOCATION OF PRGLPOSED CONSTRUCTION OR ALTERATION: OWNER OF PROPERTY: )( vr, i _ /c/cirP.) oe SSd''t) OWNER MAILING ADDRESS:s . ?O, c1X ?SS c o k AJ 1)i-7 / k� (.1 r OWNER PROPERTY ADDRESS: —Pr/1y ', ScCrtito k TELEPHONE NUMBER OF CONTACT PERSON:7 c 1 (,i-Gr, 765-25-7510'i ltue TAX MAP NO. : Section ] Block 3 Lot 6,?. CROSS STREET: TpIilN C1'- GLjbiejn 21; BUILDING PERMIT NUMBER CROSS REFERENCE: 1 K.1-41" /. Signator of Applicant RECEIVED B Y: Wif--"'` own Clerk's Office DATE: (9-(1)I ! H.S. NO. ZGQMaIO ` Q,' �a STATEMENT OF INTENT ^�• S. 1 i—________._____=___ I THE WATER SUPPLY AND SEWAGE DISPOSAL \v c C_ �U 26 E. N' I) j SYSTEMS FOR THIS RESIDENCE WILL p- t0 = 7 09 tt► 1 CONFORM TO THE STANDARDS OF THE ,'-\q�. - _ - - ! _ �` cv N _ `J"' ! i SUFFOLK CO- DEPT- OF HEALTH SERVICES. (SI v� �� C Q_r � � APPLICANT 0, •‘,.. ,40 I 0f--. ` SUFFOLK COUNTY DEPT. OF HEALTH cST i?CLE Co- ; �GJ Q � s i SERVICES — FOR APPROVAL FOR CONSTRUCTION ON Q v^v • ,pl� IS \ N' < j DATE: �� 3; . �,,� , • 3 ; H.S. REF- NO.: RID —el 9 \` ;Is`Y• `` i `, IIC ED: \�`t, _ !L 0 C/tiiR 2.12.14:314-O, tC. T,; S,` \���`dY :mop •,+site�— ' j f SUFFOLK CO.TAX MAP SIGNATlON: S • 900!s�Y.:.� , DIST. SECT. BLOCK PCL. / , s_✓ �°%c�,,O 1000 69 3 o.S p SO exam. 2 OWNERS ADDRESS: � • l as ODi ;;:ac., � P.O. BOX $55 E ' 0 ° 4In I SOUsHOLi} N.Y, i197 • E: m _ 11 1 O f i z SCALE :° I 1 f2E5.765-57% 8U5•'+?'a?3862 N•64.41.50 \Al. dl-�52 ( AREA=Q1,088 S.F. `` ED: L. P. W — I ` 0:MONUME'+J_ \ 1 i DE I usworimmilTEST HOLE i i STAMP , reYaswgrisaiYtasrat E:-.1 ' sastml7MdrtMs SVat Itsts ` I ..�_ arrrrt� •_ '+"'.. TOPSOIL Qa�iwattarasww•rryast2sr.iq \- ' :VAC.\. NOTES: 1 i_ +a erttaU*wssysr►tesaasrr Y, -:::, ;' LOAM lyCj' �ssssw lawtatrlrtMaaaata wd I.LOT NOS.t2EF'EQ-TO MAP. OVA MIiJ�2 SUBDIVISION 4 SANDY tG�h! rk.wwwatnw.� MADE FOR RUSSELL E#JOAN A.hMt�tly. __ MtstoMlse1mM oast riaw ,� II GRi1IJEL ryr•l•••=strdneammy 2.0121.ITOUR REFERS TO MEAN SEA LEVEL 2Y ''o"+ _i°+r +r.awwtxor...w4rwqine /� �J SAND II ! ra nsaisa memismoortar MAP OF PRQPE Z;V r ��1 a,04 l �� �- . - `�(-r ...� S.C. DEPT. OF L """".rlt""'ttw"'__ — HEALTH SERVICES 41le addiland A =I�RVEYED ;�2 , pt,,,,L, LE N0.2�129tr l SAND t ,,�,,,a VEV IN 2N AT f I ---- z --�_ • ,, ' �GBA� • u i:-4.2 _- Rae_try NATIONAL LE 11•ISURAMCE CO, SAND It �" v44�4 TO ti• —— SOUTH n n 1 OF-NY. — C -- kir:2r, ,9 SCATrEt2E0 2* r * r _W. i F SOU: H v ti AS SURVEYED E -- __ — c>ttAVEt {y SINGLE FAMILY DWELLNG ONLY RODERICK VAN TUYL.P.C. ( 1 1.g '`"`''' Toe; EXPIRES THREE YEARS FROM DATE OF APPROVAL �' Y~. 47.=WEys�b LS r'.;4','' •► LICENSED LAND SUR ORS 20' LIMO • , GREENPORT NEW YORK