HomeMy WebLinkAboutWilsberg, James (2) rfo��S11EF0��V
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ELIZABETH A.NEVILLE 111_� 'y ; Town Hall,53095 Main Road
TOWN CLERK o P.O. Box 1179
REGISTRAR OF VITAL STATISTICS
Southold,New York 11971
'F �� Fax(631) 765-6145
MARRIAGE OFFICER 4,►L 0
RECORDS MANAGEMENT OFFICER = s7Q1 �a�!,i� Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER ,�' 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. 3193 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : JAMES WILSBERG
Address 1: PO BOX 1429
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR ONE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. REF #R10-04-0024
Name Of Owner WILSBERG, JAMES
Mailing Address 1 PO BOX 1429
City St Zip MATTITUCK NY 11952
Property Address 1 665 BAILIE BEACH ROAD
City St Zip MATTITUCK NY 11952
Tax Map No. section 99.00 block 3 lot 21.001
Cross Street EAST SIDE AVENUE
Building Permit Number Cross Reference:
Issue Date: 9/01/04 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
stFfo
� � Go ; 3153
ELIZABETH A. NEVILLE �� p � Town Hall, 53095 Main Road
TOWN CLERK t •
tris Z P.O. Box 1179
REGISTRAR OF VITAL STATISTICS % 1� Southold, New York 11971
MARRIAGE OFFICER
�� Fax (631) 765-6145
��
RECORDS MANAGEMENT OFFICER = 1 4 *9 ��
p!11.1 Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ._, ,.i" southoldtown.northfork.net
JUN i 0 AUU4 OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: '' Southold Towriell;ding Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: June 16, 2004
Transmitted herewith is a copy of application No. 3334 for a Cesspool/Septic Tank Construction
Permit submitted by:
James Wilsberg
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.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments:
Signature
a474.-e-4.2- .2.64);
Dated
,,0,�oiOSUFFOi,�Co
ELIZABETH A.NEVILLE ��h`Z` %%I
Town Hall, 53095 Main Road
TOWN CLERK % q - P.O. Box 1179
t H Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER :,a. As i
O $ Fax(631) 765-6145
�
RECORDS MANAGEMENT OFFICER = 04 Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER _ '' * 1,aa'� 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 J or Non-Residential @ $25 Application No.3331
` r Permit No.
Applicant Name Uc e S W 1 I s e rt
Applicant Mailing Address P.0 , Q ox I H oZ 1
c(10.- ;3'ucv. )\) (Y. 11gse7
Septic Tank.1 or Cesspool
Brief Description of Proposed Construction or Alteration
Suite New \-louse,
Location of Proposed Construction/Alteration:
Owner of Property: 3-a ri.e s i I SIe.s
Owner Mailing Address: S 0,
Owner Property Addres: 6 a. 1 e. ea cL .
V1 a,N-}t�vck work,
14o�'!
Name and phone number of contact person Sar..es W i �S6� acts'—scPs o or a98-8393
Tax Map No: Section 9 9 Block 0 3 Lot a I .
Cross Street e Sick AVC_ •
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
-%J' G1 1 oy
Signatufejof Applicant Date
Received by: 5
.—�-- —+
A N
SURVEY OF LOT I ��,,.�� ��
MAP OF ORE6ON HEI 6HT5 ��2-7 � a , ' , / W s E
FILED MAY 27, I 188 FILE No. 8532 . ► �Q4 �` �/
SUFFOLK COUNTY DEPARTMENTOFHEALTH
SERVICES ' r,,,\
SITUATE:MATTI TUCK �`�"�'��' IP �� ' _ �\ �k , '�
-myth
O 4.:)6...\v-`3 i �g ` PERii `?rE�RAPPROVAL
SUFFOLK GOUKTY, NY ,:c4' - ,AC•t) + Q��' N ;aj' �, 5 ONLY
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SURVEYED 1-15-04 VIII.' a 3. •� 4 / \ P
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p 4, �' � a°• / / go � �+ DATE HS T:EF. tVO.
AMENDED 02-03-04p `�, . gyp' ppb p.�A�' �� PPROVED
TOPO ADDED 02-O6-04 AGO .:§11' �, �¢p 4• M. , '
401' 401-p��, +� �, g4� p4 Ay '�® r \ / O AX3IIYUM OF_ BEDFOOMS
SUFFOLK COUNTY TAX # �T \ \
1000-(N-3-21.1 9 Q� O-'., ' p4 p4' �c� / ' ....-
\ / \ ,�\ \ , +• �YEARS FROM DATE OF APPROVAL
SUFFOLK COUNTY DEPT. OF HEALTHc Cep �i�0 �i \ \�I --'„,`:-
12-04-05
Test Hole
SERVICES REF. # RIO - 04 - 0024 ,,4, 01' 14°I''
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Y l� • ,+ vialotbn of sectNew York Stcd£tlucoatbn Law
VU •v�I 1 I I I ' �J V ' O� \/ t/�� i-'1-> qy 'Qy copies from Ne ori9lnal of tM1 z survey
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• MONUMENT ate, '-
`\ f .• stampetl xol Shall be consitler a to ba vo Itl e
r/ °< $6
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A STAKE Q, hate,
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�fl I l,.�Yoy� \ \ \c�4j , e ,� 2_y htrg Code of vrouk for l�eSurvey,M1ew.
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CD \ \ \ �FQ,/�q};R_ _. �{T,A�q� by the Nen York State Association of Profeeulanol
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I� I I \ \ Vel$A SW Land
Land Surveyor,
for Sold
certification,shod run
ZONE DISTRICT R-40 only
11 I V(� to on a
arta on hb behalf to the tele company,gover nen
��r tel agency and lending institution listed hereon and
\ to the aa5 gnees of Lha landvg rest Lvt an. Gert f ca
ELEVATIONS REFERENCE COUNTY TOPO MAPS ((�� / e\4.1. I / / o a e amfe able to atltlltla al nst t•t a z
JOHN C. EHLERS LAND SURVEYOR
AREA = Gb,c185 SF OR 2.23 ACRES ` o / / / / /
0\. \/ / / / / - 6 EAST MAIN STREET N.Y.S.LIC.NO.50202
GRAPHIC SCALE 1"= 50' / / / RIVERHEAD,N.Y. 11901
INII Ell I= 11111111=111111 Y. 369-8288 Fax 369-8287 REF.-\\Hp server\d\PROS\03-308.pro
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