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HomeMy WebLinkAboutTorkelsen, Peter SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 3316 R Residential X Non-Residential Fee $ 10.00 Septic X Cesspool PERMIT ISSUED TO: Name : TORKELSEN BUILDERS INC Address 1: PO BOX 1475 City St Zip SOUTHOLD NY 11971 Descripton of Proposed Construction or Alteration SANITARY SYSTEM FOR SINGLE FAMILY DWELLING. APPROVED AS SUBMITTED MIDAS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES. REF #R10-05-0019 Name Of Owner TORKELSEN, PETER Mailing Address 1 800 SUMMER LANE City St Zip SOUTHOLD NY 11971 Property Address 1 800 SUMMER LANE City St Zip SOUTHOLD NY 11971 Tax Map No. section 78.00 block 90 lot 18.000 Cross Street MAIN BAYVIEW EXT. Building Permit Number Cross Reference: Issue Date: 5/18/05 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) III, r- ,„ .,... ••,,��'c S0Uly0 33I 4 ELIZABETH A. NEVILLE $ A0 4 Town Hall, 53095 Main Road TOWN CLERK * Jr, P.O. Box 1179 REGISTRAR OF VITAL STATISTICS t N ?e 1 Southold, New York 11971 MARRIAGE OFFICER : Fax Fax (631) 765-6145 RECORDS MANAGEMENT OFFICER �. .0 Telephone (631) 765-1800 FREEDQM OF INFO MATION OFFICER IgCCUN,� s° southoldtown.northfork.net --) f tU, << ' •---... ,s, , I ill APR2 1 �, OFFICE OF THE TOWN CLERK s .1"t _�'w�t ! TOWN OF SOUTHOLD f ! ., t'!-PT TO: Southold Town Building Department FROM: Linda J. Cooper, Southold Town Clerk's Office DATED: April 21, 2005 Transmitted herewith is a copy of application No. 3461 for a Cesspool/Septic Tank Construction Permit submitted by: Torkelsen Builders, Inc 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: '.�i y_ 4 rirtr-ve..7•V Signature g‘t. ., iL� '' os— Dated • 1 I ti if if'OFFOLt ELIZABETH A.NEVILLE �phy0 002\ (fe` Town Hall, 53095 Main Road TOWN CLERK aP.O. Box 1179 REGISTRAR OF VITAL STATISTICS , Southold, New York 11971 y MARRIAGE OFFICER : �` �� Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER \-:** to����� Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER -_ 4 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 or Non-Residential @$25 Application No.(124 Permit No. Applicant Name /O(ZA 6 Jo.4 eo/uQcP2J art. Applicant Mailing Address 63. c) Qor "{7f S0 u.0ot-t' to Septic Tank I or Cesspool / Brief Description of Proposed Construction or Alteration IV&l v H-o Location of Proposed Construction/Alteration: Owner of Property: 1)67-6--a- ToI(r.eFLJ ' Owner Mailing Address: goo JV/h melt '-13 c,' Svv-'Hot yu `L 1/c7/ Owner Property Address: FOC) Ott)/ /n4-7t / Awe S0w, 1,1o4O w. < 115?/ Name and phone number of contact person To r'L 12 a re-2J0) 3 7' FO 7 22? Tax Map No: Section 7 Block © j Lot e Cross Street °11 to 4H`1 vicKA, NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVEY H HEALTH DEPARTMENT APPROVAL COV)) `(/2 o16,/ Sign a of Applicant Date Received by: 0 �, 1 o \ 41: 3�' Roto SURVEY OF PROPERTY (1/r, AT BAYVIEW �`� TOWN OF SOUTHOLD Qt 02 SUFFOLK COUNTY, N. Y. s.1% 1000-78—,09-1,8 N or SCALE: 1 20 N 18 APRIL 20, 2000 oyas, s, C Dee 29 We?* (pop newhsc) GG`` cZe- ,, N / , ii Q4' ( ?i 1 a ,,�,, ,� ,� / f ,� . v `rte ,� ,„ 4, ,_ 6��,@ u��` SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES _,..N.7rr ,,,. , `��/@ hb oo���' / PERMIT FOR APPROVAL OF CONSTRUCTION FOR A -7 /s) . �``�'�/s�r�c�� • v., cy!s\� ). / SINGLE FAMILY RESIDENCE ONLY IL, a IP 'rii 0* ,,,, ,, : . l Y o s'/ b DATE 2O"0± HS REF.NO.J.,10--0T-CV Y. ► 40T ..Q IQ Q° J APPROVED , A.4. 4 y,���A ' W 1,g / �� FOR MAXIMUM OF _LE BED-.•• S Allks i it� ;_ ,� ,,,.:,, , , fp i is / l EXPIRES THREE YEARS r ROM DATE OF APPROVAL `'op,,, - /O2.' \ / r <.• >, .�Q �6 N N • �.�� Le LOT NUMBERS ARE REFERENCED TO "MAP OF .4-070 6yr e ` BA YSIDE TERRACE FILED IN THE OFFICE OF THE � SUFFOLK COUNTY CLERK ON MAR. 11, 1953 AS /leey',,' MAP NO. 2034. ,.2' 440 h, / (bDs 5 CERTIFIED TO: ■=MONUMENT 74 .. 4.-pF NEW',, 04) 400TH 1 ,� 4,V-vo.MET, 0 1- AREA-10,910 S,F-, � ,, �° , A# w 4 NO SURFACE WATER WITHIN 300' Y 3 x�s` y nit 81. .S. LIC. NO. 49618 ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATIONOF ^ ` Y'A -E Ti L:rAic 4 ' T', P.C. SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW, vi. 4 y (631 =' ` '' % % FAX:(631) 765-1797 EXCEPT AS PER SECTION 7209-SUBDIVISION 2. ALL CERTIFICATIONS /C11 HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF P. 0, BOX 909 SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR 1230 TRAVELER STREET O O — 16 6 WH ' N.Y.OSE SIGNATURE APPEARS HEREON '' SOUTHOLD, 11971