HomeMy WebLinkAboutBoergesson, William (2) oc��F F 01.
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JUDITH T. TERRY
Town Hall, 53095 Main Road
TOWN CLERK Z p r= • P.O. Box 1179
REGISTRAR OF VITAL STATISTICS �` Southold, New York 11971
MARRIAGE OFFICER y0 �. •,, Fax (516) 765-1823
'y0 ���0� Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 826 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : WILLIAM & VALERIE BOERGESSON
Address 1 : 4860 ROCKY POINT ROAD
City St Zip EAST MARION NY 11939
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILY DWELLING WITH CESSPOOL SYSTEM.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES ON 2/7/92.
Name Of Owner BOERGESSON, WILLIAM & VALERIE
Mailing Address 1 4860 ROCKY POINT ROAD
City St Zip EAST MARION NY 11939
Property Address 1 536 LEEWARD DRIVE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 79.00 block 7 lot 38.003
Cross Street JACOBS LANE
Building Permit Number Cross Reference:
Issue Date: 5/01/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
,o��FFolireoG
JUDITH T. TERRY ; • 4G Town Hall, 53095 Main Road
TOWN CLERK '71 P.O. Box 1179
►
REGISTRAR OF VITAL STATISTICS : Southold, New York 11971
MARRIAGE OFFICER =yQ�, �O�,�••• Tel Telephone (5 6) 765-1801
‘V°4, Fax
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
To: Southold Town Code Enforcement Officer
From: Linda Cooper, Southold Town Clerk's Office
Dated: April 17, 1992
Transmitted herewith is a copy of application No. 848 for a Cesspool/
Septic Tank Construction Permit submitted by:
William & Valerie Boergesson
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 X
DISAPPROVE
Comments: 444..&%.%'(�
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Signature
Dated
OFFICE OF THE TOWN CLERK fec,�FFJ(,,c:
Town of Southold 0t, - 0
Judith T. Terry, Town Clerk ��r.r.�s Application No.87 �
Town Hall, 53095 Main Road o i" ' =�
"x .: Construction
P. O. Box 1179 � ch .c Alteration
Southold, New York 11971 O
Telephone 0OI r t ,�� Residential I/
(516) 765-1801 Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE / - / 7- /,z
APPLICANT NAME: i/, /1e, � ✓a ��� Seinestes s�
APPLICANT ADDRESS: Vf'O 44,7 j�� cS C 7 v- 1 993
f
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
/l/P�/ 6 rt 3 e
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
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OWNER OF PROPERTY: 11J C_,. 41„,e, U `p,-./_•P /70-ectregfo k----
OWNER MAILING ADDRESS: -ft,'-e.)
/793
OWNER PROPERTY ADDRESS: .5""?‘„ P .-c-,
714 ‘P 6..1/ I /( 7 /
TELEPHONE NUMBER OF CONTACT PERSON: /f77-v3 fP-
TAX MAP NO. : Section Irl' Block 7 Lot
•
_ CROSS STREET: % 1 A5 /e -e
BUILDING PERMIT NUMBER CROSS REFERENCE:.
Signature/4 Applicant
RECEIVED BY: .I S
Tow Cler. s Office
DATE: - - qc
t - The locations of wells and cesspools shorn hereon ye from field
observations and or from data obtained from others.
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SURVEY OF
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4/6 •45. 11.1
P LOT
AREA .918 acres /0 0 29 & P/0 LOT 30
MAP OF
"LEEWARD ACRES AT BAYVI EW"
ELEVATIONS ARE REFERENCED TO FILED JUNE 4,1971 FILE NO. 5599
AN ASSUMED DATUM
CERTIFIED TO, AT B AY V I E W
WILLIAM BOE G SSON
illGo oc pf, 27TOWN OF SOUTHOL D
� " `'�' '�
st�?G�' � ' � (� /r131 SUFFOLK COUNTY, N. Y.
CSV 1177-03f V
The wafer supply and sewage disposal 1000-79- 07- P/0 38.1
systems for this residence will conform Scale 1 '1= 60
to the standards of The Suffolk County JAN. l 7,1992
Department of Health Services.
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SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES t"11;i'�,
FOR APPROVAL OF CONSTRUCTION ONLY 7 ', •.`
n -;5; 1. 'i/�, , :°� N.Y.S. LIC. NO. 49618
DATEFEB V 7 19 •
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