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' ELIZABETH A.NEVILLE •�`Z Gym; Town Hall, 53095 Main Road
TOWN CLERK p P.O. Box 1179
y Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS Fax�t Fax (516) 765-1823
MARRIAGE OFFICER �� * %\'1 Telephone (516) 765-1800
RECORDS MANAGEMENT OFFICER : -Ql �a
FREEDOM OF INFORMATION OFFICER % 4.0 ��gg����
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1899 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : LARS TORKELSEN
Address 1 : 1130 GLENN ROAD
City St Zip SOUTHOLD NY 11971
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. REF #R10-98-0086
Name Of Owner JOHANSEN, RICHARD AND WIFE
Mailing Address 1 611 MONROE DRIVE
City St Zip CENTERPORT NY 0000
Property Address 1 WEST COVE ROAD
NASSAU POINT
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 111 .00 block 3 lot 17.000
Cross Street
Building Permit Number Cross Reference:
Issue Date: 7/21/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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kill OFFO�,r� 101
ELIZABETH A.NEVILLE �h`t� %��` Town Hall, 53095 Main Road
TOWN CLERK P.O.%4p :4 % Box 1179
• tiZ % Southold, New York 11971
REGISTRAR OF VITAL STATISTICS 1.1••°,‘, �'i Fax (516) 765-1823
MARRIAGE OFFICER :` ,L ��
RECORDS MANAGEMENT OFFICER : 24 ��%��� Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER ��
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: July 7, 1998
Transmitted herewith is a copy of application No. 1974 for a Cesspool/
Septic Tank Construction Permit submitted by:
Lars Torkelsen for Mr f Mrs Richad JohanseR
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 1
DISAPPROVE
Comments:
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1. 61
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OFFICE OF THE TOWN CLERK ','' �uFf UL '
TOWN OF SOUTHOLD ���' Ql/ ; Application No.197
FI V AB ,
ETH A.NEVILLE,TOWN CLERK 4 •
P.O.BOX 1179 Construction
SOUTHOLD,NEW YORK 11971
Alteration
0 00 Residential
Telephone 'y.�fl0 S�o�,'. C -�
(516) 765-1801 = 1 Jo $25.00 -Non-Residential
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $ Q
DATE (i'L ! 7, / 9 U
APPLICANT NAME: 4-i Q/QrL'L 5 Lv
APPLICANT ADDRESS: 1/ 3 Q Lor ..- l-
SEPTIC Y.- CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION // /.7-M.,
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: MR.. fl /Q/(g4/Z J J 0/ 4/L.cg4..J
OWNER MAILING ADDRESS: 61/ 'IDvd'sbr Do . C1-it-T Ri°n2T /L�
OWNER PROPERTY ADDRESS: ///j S V P0/4-T So (/1 /91OLe
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section ` Block d 3 Lot / 7
CROSS STREET: •" DLA ot,0-5r Co or /Q faiIt.A
BUILDING PERMIT NUMBER CROSS REFERENCE:
47‘4,
Signature of Applicant
RECEIVED BY: -sr
T w Clerk's • lc-
DATE: 7 / 9 q W
l am familiar with the STANDARDS FOR A L t AL �` H S '" ^' I : 1/4 N
• AND CONSTRUCTION OF SUBSURFACE ', `�"""ICOR APPROVAL OF CONSTRUCTION FOR A
DISPOSAL SYSTEMS FOR SINGLE FAMILY 4;"" ES all,NGIZ FAM LY RffiXDINCE ONLY
and wits abide by the conditions se/ forts , on the
permit to construct. • - ;fi DAEtSREF NO p r...1$-Ots8-C
AIPRiOVED -16....,,,......6.,... ___
'1 Ya
ca f MAMMON(OF, !*.••MS
Q. MLOT �R�ZAIMS YEARS FROM DATE OF APPROVAL
/ o s
\ , Q 79•_jos, tots vo. E ��, t `\ ``
3 y I 1 I .-1
, 1
8 1 ' Bzos s 1 r 1 ,1-... l
0\ (1> SURVEY OF
I / /
AL1 01i ' de-
' � ; ., REVISED SUBDIVISION
wellin
3 I I I1 ti
1 PROPERTY OF
s/i C 9 O 0 3O• rI I a, Prop tit hseivr i //- ----
-— — AL Q BEING o JERSEY W ,:1;.2%
E•
IC"- Z-P 11• I r l „ ', NASSAU POINT CLUB .,..-
' b 1 1 I I Lor • \ /I ii 9fRf1✓.
0 , i I0 1 ' • l lI 1 h LOT FL 28, fBD Fa € No. 785 8
V Pr�� , dX'� .--
ill
, '� j \ A T NASSAU PAINT nEST Hae
2 I I �\ � TOWN OF SOUTHOLD
Fro I I I SUFFOLK COU T Y, y.. Y. Brown
t347',.. 1000 - 111 - 03 - 17 ' ' sw
I 1 Prop .. =
1 / r .v21///� - e'' Sidle 1// /�, J*
W ily
�, l ser e .2• , • -' ''° IVa v. 15, 1990
% ' Lot i Nr `- JUKE 3, 1998 t prop. ' I
o ''4)1
, o I er re r�,199�(a.e wellawn
/ h 4. / vete...,"yI 1 r \
:its
wri SW
F \ / `
O
The locations of wells and cesspools
shown hereon are from fold observations
Avn and or from oidia obtained from others. I.
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