HomeMy WebLinkAboutBerkhan, Theresa �'���, Town Hall, 53095 Main Road
0 ��' P.O. Box 728
O'l ;,�'� Southold, New York 11971
-.,.. /1
JUDITH T.TERRY TELEPHONE
Town CLERK (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
August 28, 1986
Theresa E. Berkhan
Thomas W.. Berkhan
P.O. Box 385
Southold, New York 11971
Enclosed herewith is the Construction, Alteration or Modification
Permit for a Septic Tank or Cesspool System for which you applied.
Please be advised that each owner of real property operating an
on-site sewage disposal system, such as a septic tank or cesspool must,
prior to such operation, possess in the name of the owner an.Operation
Permit for the system. The Operation Permit is issued by the Town
Clerk's Office.
The fee for an Operation Permit is ten dollars ($10.00) for •
residential use and twenty-five dollars ($25.00) for non-residential.
Please have the owner complete the enclosed Application for an Operation
Permit and return it to this office along with the proper fee.
For your general information I have enclosed an Informational
Bulletin regarding the Scavenger Waste Laws adopted by the Southold
Town Board. Should you have any questions pertaining to either permits
or the Scavenger Waste Laws, please do not hesitate to contact this
office. We will be glad to assist you in any way possible.
Very truly yours,
Judith T. Terry C
Southold Town Clerk
Enclosures (3)
JTT/Ijc
OFFICE OF THE TOWN CLERK c0FULJ Z
Town of Southold ((j
Judith T. Terry, Town Clerk .` L:
Town Hall, 53095 Main Road
P. O. Box 1179 :v'
Southold, New York 11971 O�y� � �
Telephone _ �l t
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 18 Residential XX
Non-Residential
Fee $ 10.00
Septic Cesspool XX
PERMIT ISSUED TO:
NAME: Theresa E. Berkhan
ADDRESS: 485 Pine Avenue
Soutohld, New York
DESCRIPTION OF PROPOSED CONSTRUCTION or ALTERATION
New house
LOCATION OF PROPOSED CONSTRUCTION or ALTERATION:
OWNER OF PROPERTY: Thomas W. and Theresa E. Berkhan
OWNER MAILING ADDRESS: P.O. Box 385
Southold, New York 11971
OWNER PROPERTY ADDRESS : Shepard Drive
Southold, New York
TAX MAP NO. : Section 78 Block 1 Lot 18
CROSS STREET: Glenn Road
BUILDING PERMIT NUMBER CROSS REFERENCE: Pending
�. air."-...�.r"
Judith 'f. Terry��7.
Southold Town Clerk
DATE: August 28, 1986
(TOWN SEAL)
BOO
(i"x"--441!:
too,
����ycf) Pg
Town Hall, 53095 Main Road
`
AUG 8 4 Nt— 41 P.O. Box 728
1114 o'� Southold, New York 11971
JUDITH T.TER. ' ""' ..... TELEPHONE
ToWNrCt ���
- -.. .__ (516)765-1801
REGISTRAR OF VITAL STATISTICS -" OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
August 8, 1986
To: Victor Lessard, Southold Town Building Department
From: Judith T. Terry, Southold Town Clerk
Transmitted herewith is a copy of application No. -16 for a
CONSTRUCTION or ALTERATION Permit for a cesspool or sec system
submitted by Theresa Berkhan
Please advise if the project has received Suffolk County Health
Department approval and if we may issue the permit .
Judith T. Terry
Southold Town Clerk
Attachments
OFFICE OF THE TOWN CLERK
Town of Southold Application No/6
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road Construction
P. O. Box 1179 Alteration
Southold, New York 11971 /
Residential
Telephone
(516) 765-1801 Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $ / `D
DATE 1) .� s.., U , 1 1G
8-4
APPLICANT NAME: / h Cc -e-S E . Be- rh4n
APPLICANT ADDRESS: 9 '3 S^ 9 J n e t2
ga Of' h,0 id / 01 • )/l71
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
K.) C.,‘‘..) OL)&
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
r
OWNER OF PROPERTY: o tvtaS (A) is � t � eS � � � k aa}
OWNER MAILING ADDRESS: I CQ
S0 vk- ko1di U ,(. 1197 /
OWNER PROPERTY ADDRESS: S n G rci) r •
bv101y
TELEPHONE NUMBER OF CONTACT PERSON: G 3-- /8- 62.,
TAX MAP NO. : Section 0 7 8 Block } Lot 1 8
CROSS STREET: G- 1 -_n n
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of Applicant
RECEIVED BY: Ct � � 1
Town CI k's Office
DATE: F A.
• .
PLEASE NOTE H S NO
FiRN - -.L-T.-ws-- 1,!13* ie--the Hca s responsibility
!E._.= �. k .gU . 170. 00 ,� stairs--Adequate sanitary distance
between all water supply and sewage
disposal
{ - ., facilities.
2 A' I STATEMENT OF INTENT
N : , f� :. �� �` + ,ti THE WATER SUPPLY AND SEWAGE DISPOSAL
7 I- - -..=-.2::.':-..-_-9 9_-x = , - ��.r�:..� i'.?; . '...• "`,A,•:1"°`:..�c invigni iispEgligli 1 ,1 Al� I SYSTEMS FOR THIS RESIDENCE WILL
` 1 I CONFORM TO HE STAND RDS THE
't•'. YT 4.._. i,�:.s '' '-'riPIRES IWO YEARS fROhi j SUFFOLK CO. T OF HE H S ICES.
`
41DATE "�VAL (S) APPLI ANT
fid° vac • S I i ,
SUFFOLK COUNTY DEPT. OF HEALTH
0 � Y� SINGLE FAMILY DWELLING ONLY SERVICES - FOR APPROVAL OF
38 P EXPIRES TWO YEARS FROMDATE CONSTRUCTIO ON Y
: \ S. OF APPR >.ALD
ATE: 1 .. t
�� UI C ; I I H. S. REF. NO.T. i
'� O APPROVED: L/1
IY m
bo , n ilG
,�� / 4 %\ q\'°' SUFFOLK CO. TAX MAP DESIGNATION:
'f DIST. SECT BLOCK PCLtii .
OWNERS ADDRESS:
1 I i 1864 ' v
EA:
A „ V E !\.i.‘'(. — 1..
i
` r � -
:2.i FNEPA2L? ;�,,`i`/ 94 5C ._ _
SCA ` 4,..-_-.'
. f I
r-. - r ' *. cyr. r
j- = --
Ci 1` --- A �.EA ;•;`--- ._ DEED: L. \ A P-
ITEST HOLE STAMP
!. - •
MOTES
I • ' .
i I Lor 1' O S. T2 E FEra To r} _ . . - - _ rrf a! ri-;n a*Y�*0K�71
iN T'4E SUFF. :.CJ._LE. '2I.' ,.:••----i- -;: ::' A. ' = i
- l p Nari srk�
ELBA': E i
G. Ott -- o; , . .: ,�M
• e 5 I --__- -_ _
t `4t'iz eunt ttSlp PSOR ^3'
c+�a ir* d sesl
4.* f�• f C se Tt£h :nOi f,3 COTsItlf�
�.. j 3 ,
i � :��.�inn�;•
- 4-1'j `1tt"i_.r<,� ; •f ( �� I ,,,,t ..,,
n tic3tsw hcrt�sil N19h FSCs
_:r, K:�:n t`fs SUMO' E
Y