HomeMy WebLinkAboutIsaksen, Stanley Jr 1,„,iii„
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ELIZABETH A.NEVILLE 'l O . Town Hall, 53095 Main Road
TOWN CLERK ; i #I P.O. Box 1179
cn Southold, New York 11971
REGISTRAR.OF VITAL STATISTICS ; G Q 1
MARRIAGE OFFICER -.4 # ,1 Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER l ,
,i Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER = . OUn 1 i5\\\ .°,,. 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. 3453 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : STANLEY J. ISAKSEN JR.
Address 1: P 0 BOX 294
City St Zip NEW SUFFOLK NY 11956
Descripton of Proposed Construction or Alteration
- PRELACE EXISTING CESSPOOL WITH 8 X 12 OVER FLOW POOL
-MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS, BUILDINGS, PROPERTY
LINES, AND WATER BODIES. *EXCAVATION INSPECTION REQUIRED*
Name Of Owner STANLET J. ISAKSEN JR.
Mailing Address 1 P 0 BOX 294
City St Zip NEW SUFFOLK NY 11956
Property Address 1 455 KOUROS ROAD
City St Zip NEW SUFFOKL NY 1195
Tax Map No. section 117.00 block 6 lot 11.200
Cross Street GRATHWOHL ROAD
Building Permit Number Cross Reference:
Issue Date: 7/19/06 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE '` O Town Hall, 53095 Main Road
TOWN CLERK 44 lig 4 P.O. Box 1179
tr S New York 11971
REGISTRAR OF VITAL STATISTICS c,)G Q SSouthold
MARRIAGE OFFICER �O ( Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER : 4I Telephone(631) 765-1800
FREEDOM OF INF-ORMATION OFFICER court ��� southoldtown.northfork.net
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JUN 2 2 OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
1
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: June 21, 2006
Transmitted herewith is a copy of application No. 3608 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Stanley J. Isaksen,Jr.
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 V
DISAPPROVE _
Comments: Maintain required setbacks from adjacent wells, buildings, property lines and water
Bodies. EXCAVATION INSPECTION REQUIRED.
/'/ G4,/
Signature
Dated
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ELIZABETH A.NEVILLE ,�h`1` O4 L Town Hall, 53095 Main Road
TOWN CLERK z
P.O. Box 1179
REGISTRAR OF VITAL STATISTICS 1y Southold, New York 11971
MARRIAGE OFFICER : G '� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER =y� O ••I Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER '� * �a.,� 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 ► .. O
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Permit No
Applicant Name 1•3ti�y ,T TS/1/Ci// 7
Applicant Mailing Address ��,� 7V
///i' . �.�.� 2 /y ' ,/75-6
Septic Tank or Cesspool
Brief Description of Proposed Construction or Alteration 7 L�
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Location of Proposed Construction/Alteration:
Owner of Property: . /Ey �s y/zti T2
Owner Mailing Address: ..-4 o795'
Owner Property Address:
Name and phone number of contact person/d77,/g4t S71riE s,
Tax Map No:ICS Section 1 1"7 Block GY' Lot CI I-Z
Cross Street , ,,ri�
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
S,iL., ignature of Applicant Date
Received by: hI a
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?j SURVEY OF
DESCRIBED PROPERTY
SITUATE
NEW SUFFOLK, TOWN OF SOUTHOLD
, SUFFOLK COUNTY, N.Y.
ONLY HE'NDICATED HERE ON PERSONFORWHOMTHSESURRVN VEY SURVEYED FOR: STANLEY J. ISAKSEN, JR. SURVEYED: 5 JANUARY 2006
TITLECOMIS �PANYY,GOVVE"R'SNMEN HALF AGENCY, MILDRED L. ISAKSEN
LENDING INSTITUTION,IFLISTEDHEREON,AND
SCALE 1"= 20'
TO THE ASSIGNEES OF THE LENDING INSTITUTION.
GUARANTEES ARE NOTTRANSFERABLETO TM# 1000-117-06-011.2 AREA = 17,633 S.F.
ADDITIONAL INSTITUTIONS OR SUBSEQUENT OWNERS. OR
UNAUTHORIZED ALTERATION OR ADDITION TO THIS 0.404 ACRES
SURVEY ISA VIOLATION OF SECTION 7209 OF
THE NEW YORK STATE EDUCATION LAW.
COPIES OF THIS SURVEY MAP NOT BEARING SURVEYED BY
THi NOroETBEECDaONNSI RED SB�,EuDIDTRULe"ALL STANLEY J. ISAKSEN, JR.
COPY
P.O. 80 294
NEW S �OLK. N.Y. 1 19
631 -7f4-5835
GUARANTEED TO:
STANLEY J. SAKSEN, JR. •�-
MILDRED L. ISAKSEN k. � I _ /_
I SEP • 0 SURV /OR
NYS Lic No 49273 06R1463