HomeMy WebLinkAboutTorkelsen (2) `11 lea,
JUDITH T."TERRY F+ Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS � Southold, New York 11971
MARRIAGE OFFICER ® ®�
Fax (516) 765-1823
---_-cro 4, � • Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 2023-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner TORKELSEN, LARS
Mailing Address 1 1130 GLENN ROAD
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 1130 GLENN ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-3174
Tax Map No. section 78.00 block 2 lot 29.000
Cross Street MAIN BAYV I EW ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 12/23/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK c3vFFOCA/
0
Town of Southold � „ .x:. CQ ' Application No. 0
Judith T. Terry, Town Clerk �
`,
Town Hall, 53095 Main Road _ :;,� $10.00 - Residential
P. 0. •Box 1179 CI) fi $25.00 - Non-Residential
Southold, New York 11971 �
• STelephone : j
417 0°
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE
OWNER NAME: LAI S 1.88 6'L S Lsly
OWNER MAILING ADDRESS: ` 1 30 Z=. 4.'/WV /(29 I)
v r79La L,( , 11-47/
OWNER PROPERTY ADDRESS: S/X k 1 4 S Azo QL
OWNER TELEPHONE NUMBER: 7/0 3 / 7
TAX MAP NO. : Section 119 19 0 7? Block Oa- Lot 0 d 9
CROSS STREET: /4,iVti ID4 7 V/C I/(,/ I.041J
TYPE OF SYSTEM: Septic Tank pati-CA/ - New 7-d'YagiExisting 7- J'' /4/ARc DJ
Cesspool )/&S New Existing 5/SN. tl
Residential yes Non-Residential
DATE OF PREVIOUS PUMP-OUT:` 7)/3 i4-) -S /CIie5T' SC",�T7C % 411 a:
qv
LOCATION MAP: Must be attached hereto before permit may be issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
Signature of Applicant
RECEIVED BY: 4.{.-itop_a_ey.-- - - --Town CI k's Offic
DATE:
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SURVEY FOR ,
Au0 5,1995
,ENT OF HEALTH SERVICES LAR TORKELSON 8 ASTRi YORKELSON FEB. 22,1984
LOT 13i "WEST CREEK ESTATES" DEC. 19,1983
SEPT.20,1983
:ONSTRUCTION ONLY AT SOUTHOLD DATE: AUG.22, 1983
TOWN OF SOUTHOLD SCALE( I":40'
:,EF. NO._ SUFFOLK COUNTY NEW YORK . NO. 83-653
*UNAUTHORIZED ALTERATION OA ADDITION TO THIS
SURVEY,IS A VIOLATION OF SECTION 9200 Or} HE '(E OF N
NEW YORK STATE EDUCATION LAW e,•\ . EW j
14 COPIES OF THIS SURVEY NOT BEARING THE LAND
SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL Dwyb'PNOT BE CONSIDERED TO BE A VALID TRUE COPY 7(0„1:1
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SURVEY FOR
TMENT OF HEALTH SERVICES
LARS TORKELSON & ASTRI TORKELSON AUG. 22,1984
LOT 13, "WEST CREEK ESTATES" SEPTC9,20,1983
CONSTRUCTION ONLY AT SOUTHOLD DATE• AUG 22, 1983
TOWN OF SOUTHOLD SCALE: I :40'
S REF. 1:O. SUFFOLK COUNTY, NEW YORK NO. 83-653
0 UNAUTHORI2'ED ALTERATION OR ADDITION TO THIS
SURVEY IS A VIOLATION Of SECTION 7209 OF THE jE OF ry
NEW YORK STATE EDUCATION LAW ' SSP FW`
*COPIES OF THIS SURVEY NOT BEARING THE LAND
SURVEYORS INKED SEAL OR EMBOSSED SEAL SHALL seikD W. y O..1)1`
NOT BE CONSIDERED TO BE A VALID TRUE COPY p
*GUARANTEES INDICATED HEREON SHALL RUN ONLY TO 4. 4' . i,{"A+ OG
`OR APPROVAL TO CONSTRUCT THE PERSON FOR WHOM THE SURVEY IS PREPARED �I tit
AND ON HIS BEHALF TO THE TITLE COMPANY,GOVERN- (: ,: e
SOURCE OF WATER• PRIMITE✓PUBLIC_ MENTAL AGENCY AND LENDING INSTITUTION LISTED
TION 078 BLOCK Oz LOT a? HEREON,AND TO THE ASSIGNEES OF THE LENDING
HIN 100 FEET QF THIS PROPERTY INSTITUTION GUARANTEES ARE NOT TRANSFERABLE
TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT �.
DISPOSAL SYSTEM FOR THIS RESIDENCE OWNERS (� o'
C'fr 4589
*DISTANCES SHOWN HEREON FROM PROPERTY LINES
OF THE SUFFOLK COUNTY DEPARTMENT s�
TO EXISTING STRUCTURES ARE FOR A SPECIFIC 80%
PURPOSE AND ARE NOT TO BE USED TO ESTABLISH 14ND SURlE1
PROPERTY LINES OR FOR THE ERECTION OF FENCES
TEL. YOUNG aYOUNG . RIIVVERHEAD, NEW YORK
TRANDER E
uIc E
ARE REFERENCED TO MEAN SEA LEVEL ALDEN W.YOUNG,PROFESSIONAL ENGINE ER
CE OF THE CLERK OF SUFFOLK COUNTY AND LAND SURVEYOR N.Y S UCENSE NO.12845
ucz. HOWARD W.YOUNG, LAND SURVEYOR
.NK(STIBCESSPOOLS(cP)SHOWN HEREON N.Y.S.LICENSE NO.45893
OR DATA OBTAINED FROM OTHERS