HomeMy WebLinkAboutBohn, Robert ,/�,II'
.0"
II'
1' �� .
JUDITH T.TERRY = yet• Town Hall, 53095 Main Road
TOWN CLERK y = P.O. Box 1179
Pr7 ,$ Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER �yifJ �0)- �1�' Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER (1! �d� Fax
(516) 765-1800
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1501 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : ROBERT BOHN
Address 1 : P. O. BOX 563
City St Zip SOUTHOLD NY 11971
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR A NEW SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. SCHD REF. #R10-96-0046
Name Of Owner BOHN, ROBERT
Mailing Address 1 P. O. BOX 563
City St Zip SOUTHOLD NY 11971
Property Address 1 95 TERRY COURT
City St Zip SOUTHOLD NY 11971
Tax Map No. section 69.00 block 3 lot 6.002
Cross Street GRISWOLD STREET
Building Permit Number Cross Reference:
Issue Date: 6/28/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
VFfo /
1�,1. S7) ( •
D�OS 'ECoG
JUDITH T.TERRY � = yt Town Hall, 53095 Main Road
TOWN CLERK ; N Z ; P.O. Box 1179
cr"
%s1 Southold,New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER . y% 0` of Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER --- 49l * **pa"
*pa Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER ..0°
OFFICE OF THE TOWN CLERK i Ti my 1
TOWN OF SOUTHOLD """"� .--p t
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: June 26, 1996 .
Transmitted herewith is a copy of application No. 1566 for a Cesspool/
Septic Tank Construction Permit submitted by:
Robert Bohn •
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 recommendations:
APPROVE .f�
DISAPPROVE
Comments: -•- .,.,-5-C.14) r 49 1(-Ob c/
(.„.Z2
Sig ature
,/' ?f// /%
Dated
OFFICE OF`THE TOWN CLERK I,,,,
Town of Southold $1$"4\ f 011(C
Judith T. Terry, Town Clerk 44Q �G Application No. /6—
Town Hall, 53095 Main Road ,� �� . Construction
P. O. Box 1179
Southold New York 11971 � � Alteration
Telephone ; ��OQrI�'� $10.00 - Residential
(516) 765-1801 ./
$25.00 - Non-Residential
•
TOWN OF SOUTHOLD
SOUTIIOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. •
Fee $
DATE (/x10/96'
APPLICANT NAME: WpI r(2 'apJ- J
APPLICANT ADDRESS: la box S03 SaU? J ' thJ1' I(e7/
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
siM1(e- FAQ; �` owe 11 ;Nl
Ne(A) SZ 2 u C t.tyJ
LOCATION MAP: • Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION;
OWNER OF PROPERTY ; obe2.T 1301,NN
OWNER MAILING ADDRESS; ?b 13o>, Sotto 18 d.n-(
• II1'7I
OWNER PROPERTY ADDRESS: 915 )eR2y (+ oJ12— Sou olcl
i1/4)1/4? ttet-71
TELEPHONE NUMBER OF CONTACT PERSON: 7(, — ,(p a a O
TAX MAP NO. : Section O o1 Block 3 Lot OF w .0 o;CROSS STREET: ��R CotAer
BUILDING PERMIT NUMBER CROSS REFERENCE ;
le6
•
Sig re of Applicant
RECEIVED BY :Y . I_ Cti
wn Ierk's Office
DATE:
:•..
... • .
' . .
. '
u riFPOLIC CO.HEAL11/1.oispr.AriniqvAL.- •
. ,
, I
• ,
WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS MUST ..11
. CONFORM RYES NEW STANDARDS DATED NOVEMMER 13.OM. i
,--
su rzv Ev EC r,.., e.
)57
7- ' .--
(,./r-' i 5 , , ....._'1.\
IV) . -I "... ••••• ........ i-.ft.. ..., ' 1 NLI k_d r,..." ,
, &
(.5 . 147
. .
,.....,_ ,ccur2T 1 ; et
---7------we. \ A ___c_CWATIda MAW i
1 TOWN OF SOUT;-i-A..:‘, !,..t.-e,
p
----____._ii
r_____ ,- I 25.o • N ,
-,_ %°
• V 1 _,
------_.,
.., si ;
i ! .
N.' s rg ; ...
' i r- - \ 1 ik r _
4. tr I . 1 .
— `.- TO serrtc - 1 \
"yr 1
, -1":• --f .. 1 (4 Iii ‘ 1
cv I
I ;-• ' „, 'L (NI 4 ;a - 4 -
, J
I ,, (I• a" , , .
-
- .*_ - i \\
r PQCF '40 9t2PC. il SUF ATION:
-•--
4 \\
- ------- DIST. SECT. BLOCK
---
I 0 00 06 9 3- PE 0 Pr&•
f :I
, PeoposE0 . .1 'OWNERS ADDRESS:
I prailyiln
\
® 1 . SEPTIC SY STEM .
- \ P,a EICY 563 gi
)
ii*C4thiTi . SO 7. EXP.M. t® I
- t SCALE-56.1* k SCUTHOLD N. ,11911
AfZeke6 27t S.F. \
; .
TEL..765- 220
0:MONUMENT ,
\
• , 1.17,4
-- 1 DEED:L. p. ..firileadc
TEST HOLE -
; ti__
C-* r! Lor mblepEes gErrez•r0 susONIStoc
biAP cm S . DM A.IllAffht .
or S ELI.E 4 JA
issiserawir
• ' i. , , . ft Am 111.411011iMallilt . ..
1 Sladlem law
tLi -1:0 Ali 1 •
r Sif-Y.-S.4i1.74 VS rePliadWILISI .11 PI ailltaftt
, s . 1'MEW. . svarrearetiMelleillegaillind-_
to be aridllimillet.
-III --- 4
SAM 0 * Gamisestrasitararionitrast
'..--
r-- -4* 4 11AVEls owisserensiinioasesawa*
1._p•ii.smisihrlatiar or
2 • , .4) : — 4. te,moo*womaregrosoweld
1,,r4A41,4auronamitroommi
0 swap s la......c r tsTecli ono 6""e""
. •
iLT.un.. tle.t.Ct.,..^..:cr.ere Ad inwalms.
— = N1
• Ni.-724E;f 0*w. .!. .73 a 1 f,."/. :24 —,.
75 , saw) d
. ,
it '4 - SCATTESILD 724E; /
AS .5:4QV EYED MAY 20 ' +96GRAVEL ' "C411147'7"
' hE.--.iETt-..--.
,I, - RODErVALplY.........ti.X. '•• 0
4 ' 'CC:1•47C'4 25 74E'E7.....TC. 1-1EA.,.\... sEA LEtiELLNOvO.
T .
•• 1 LICENSED LAND suRvirrons
OREENPORT NEW YORK 20 _
..
• ,.el I
......
I