HomeMy WebLinkAboutBysheim, Knute JUDITH T. TERRY : Town Hall, 53095 Main Road
TOWN CLERK P.O. BOX 1179
REGISTRAR OF VITAL STATISTICS \tri .� Southold, New York 11971
MARRIAGE OFFICER Q �' 4, Fax (516) 765-1823
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(516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 949 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : KNUTE BYSHEIM
Address 1 : 50 HIAWATHA DRIVE
City St Zip BRIGHTWATERS NY 11718
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 12/7/92.
Name Of Owner BYSHEIM, KNUTE
Mailing Address 1 50 HIAWATHA DRIVE
City St Zip BRIGHWATERS NY 11718
Property Address 1 BAILIE BEACH ROAD
City St Zip MATTITUCK NY 11952
Tax Map No. section 99.00 block 3 lot 15.001
Cross Street EAST SIDE AVENUE
Building Permit Number Cross Reference:
Issue Date: 1/15/93 Judith T. Terry
Southold Town Clerk
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JUDITH T. TERRY : f•► Town Hall, 53095 Main Road
TOWN CLERK : p rZ Z P.O. BOX 1179
REGISTRAR OF VITAL STATISTICS V, �` Southold, New 765-1823 11971
MARRIAGE OFFICER y0 �1 Fax (516)
=:��0 ��� •�� Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
DEC 22
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TO: Southold Town BuildingDepartment . 4 ! PT.
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: December 22, 1992
Transmitted herewith is a copy of application No. 976 for a Cesspool/
Septic Tank Construction Permit submitted by:
Knute Bysheim .
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 K
DISAPPROVE
Comments: 4.w Olke
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Signature
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Dated
OFFICE OF THE TOWN CLERK c�.rFULi-,
Town of Southold . `-Oi
Judith T. Terry, Town Clerk ;�c='.` 6�_`_' Application No. ��
Town Hall, 53095 Main Road o jl,4.. ., _
P. O. Box 1179
En i ' of Construction
Southold, New York 11971 ' ` Alteration vz
Telephone
'°n i r ��� Residential
(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 1z/ 2� 1 12
APPLICANT NAME: 11
APPLICANT ADDRESS: C 0 )--\ j•A l,,) P \ 1 Y 1 J <
' ,RY 2 _! V ,V o 1 * --. s 'N -1--... l ) tS
SEPTIC CESSPOOL*
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: ) (N Vt\ �,..\ S%\c 1
• OWNER MAILING ADDRESS:
OWNER PROPERTY ADDRESS: . bn r Lr �.<<Eltil
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TELEPHONE NUMBER OF CONTACT PERSON: (o CG, C — —)
TAX MAP NO. : Section 9' i, Block _ 1
Lot
. CROSS STREET: E,- ;1 S,' ,. n ,
BUILDING PERMIT NUMBER CROSS REFERENCE:..
_____________________
1 a t_,_ 1 .
Signature of Applicant ..•
RECEIVED BY: �� /
-7/
T. wr/ et- Office
DATE:
DEC 221992 .
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place �' �\ I
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NOTE GE. iro01. 17.0'
ELEVATIONS SHOWN HEREON ARE (u'/&(2-1 reit.hYTEM)
REFERENCED TO N.G.V.D.(M.S.L. 1929) hf-c.(Io1J-SEWAGE PIy fOcOAL '' T �i., Imo iori brim
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SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES SURVEY FOR NOV.12 1992
LEONARD C.SCHLEGEL 8 DONNA M. SCHLEGEL MAR.14,1990
M A R.13,1989
FOR APPROVAL OF CONSTRUCTION OF JAN.1 1,1989
(n� 11 AT MATTITUCK DATE MAY 7,1986
AtE'Ec 0
D � amity Residence Only
� S N0. X92 TOWN OF SOUTHOLD SCALE: I" = loo'
J`�', � SUFFOLK COUNTY, NEW YORK NO. as-a30
APPROVED �```�� ] K UHAUTNORIZED ALTERATION OR ADDITION TO THIS GUARANTEED T0= •
SURVEY W A VIOLATION OF SECTION 7209 OF THE
EXPIRES 3 YEARS FROM E O APPROVAL NEW YORK STATE EDUCATION LAW
CHICAGO NE CE COMPANY
IIcormS OF THIS SURVEY NOT BEARING THE LAND ,6 Cf
SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL
NOT N GUARANTEES INDICATCONSIDERED ED HEREOBE A N SHALL[RUNPY ONLY TO AQ~ lig'''.W.
Y^O,Q�
HEALTH DEPARTMENT-DATA FOR APPROVAL TO CONSTRUCT THE PERSON FOR WHOM THE SURVEY IS PREPARED `� r
AND ON HIS BEHALF TO THE TITLE COMPANY,GOVERN- ,,,sffLLL
N NEAREST WATER NAIN MI.t II SOURCE OF WATER,MIMTE_PUBLIC_ MENTAL AGENCY AND LENDING INSTITUTION LISTED ,k I . ,,,WN91 ZW
H RUFF CO.TAX MAP DIST WOO SECTION�-BLOCK_os_.LOT ILL HEREON,AND TO TWE ASSIGNEES OF THE LENDING ',`S...
N THERE ARE NO DWELLINGS WITHIN 100 FEET OF TINS PROPERTY INSTITUTION. GUARANTEES ARE NOT TRANSFERABLE Nqc."
TO ADOITIONAL INSTITUTIONS OR SUBSEQUENT !�•' _
OTHER THAN THOSE SHOWN HEREON. OWNERS �'" . Q-
N THE WATER SUPPLY ANO SEWAGE DISPOSAL SYSTEM FOR THIS RESIDENCE N •�,WILL CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY DEPARTMENT TO DISTANCES SHOWN HEREON FROM PROPERTY SPECIFIC LINES
OF HEALTH SERVICES. EXISTING STRUCTURES ARE A
APPLICANT.
PURPOSE AND ARE NOT TO BE USED TO ESTABLISH lS `(�
PROPERTY LINES OR FOR THE ERECTION OF FENCES `/�,'�. -4
FO LANA \`
ADORE 55 .A :•.+..l_ Gr['17••
TEL. YOUNG a YOUNG 40ESTo!OER AVENUE
OR E
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NOTE ■AMONUMENT O=4 x4 POST ALDEN W.YOUNG,PROFESSIONAL ENGINEER
RE; LOT NUMBERS,EAST SIDE AVENUE 8 NORTH LAGOON LANE
ARE SHOWN ON SUBDIVISION MAP OF"OLD MILL HAVEN CO°FILED AND LAND SURVEYOR N.Y.S.LICENSE NO.12045
IN THE GUFF CO.CLERKS OFFICE ONOCT.2,I928ASFILE NO.799 HOWARD W.YOUNG, LAND SURVEYOR .
N TIC LOCATION OF WILLOW/.SEPTIC TANKISTIB CESSPOOLS(cP)SHOWN HEREON N.Y.S.LICENSE NO.45893
ARE FROM FIELD°MSCRMTIONS MOOR DATA OBTANNED FROM OTHERS
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RRARDIS & SONS INC. 1046