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HomeMy WebLinkAboutBoergesson, Erik oliSfFOti% co ELIZABETH A. NEVILLE t Town Hall, 53095 Main Road TOWN CLERK o= 1 P.O. Box 1179 N = Southold, New York 11971 REGISTRAR OF VITAL STATISTICS �� 3 MARRIAGE OFFICER Fax (516r 765-182 RECORDS MANAGEMENT OFFICER L* �� Telephone (516) 765-1800 FREEDOM OF INFORMATION OFFICER �11'1 l �•,s ' OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 2024 R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X PERMIT ISSUED TO: Name : ERIK BOERGESSON Address 1 : PO BOX 1911 City St Zip SOUTHOLD NY 11971 Descripton of Proposed Construction or Alteration SANITARY SYSTEM FOR SINGLE FAMILY DWELLING. APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES. REF #R10-97-0123 Name Of Owner BOERGESSON, ERI K Mailing Address 1 PO BOX 1911 City St Zip SOUTHOLD NY 11971 Property Address 1 4515 NORTH BAYV I EW ROAD City St Zip SOUTHOLD NY 11971 Tax Map No. section 79.00 block 3 lot 15.000 Cross Street SHIP'S DRIVE Building Permit Number Cross Reference: Issue Date: 3/04/99 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) Vow aoaK 'i„,,••y 4..- \. e ELIZABETH A.NEVILLE • y0 */y Z 'Town Hall, 53095 Main Road TOWN CLERK Ii .t P.O. Box 1179 REGISTRAR OF VITAL STATISTICS cn Southold, New York 11971 Fax (516) 765-1823 MARRIAGE OFFICER �Oy �� Tele hone (516) 765-1800 RECORDS MANAGEMENT OFFICER 0 P FREEDOM OF INFORMATION OFFICER �_ Qt jig ••0 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TO: Southold Town Building Department FROM: Linda J. Cooper, Southold Town Clerk's Office DATED: March 1 , 1999 Transmitted herewith is a copy of application No. 2102 for a Cesspool/ Septic Tank Construction Permit submitted by: Erik J. 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 / DISAPPROVE Comments: gnature AZici 6) Dated • OFFICE OF THE TOWN CLERK OtKC' TOWN OF SOUTHOLD 0'"."'���� S = Application No. ELIZABETH A.NEVILLE,TOWN CLERK P.O.BOX 1179 _ Construction SOUTHOLD,NEW YORK 11971 ^' ; Alteration Tele hone y04Q � $10.00 - Residential ✓ P (516) 765-1801 Ol *' �' $25.00 -Non-Residential TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for CONSTRUCTION or ALTERATION PERMIT SEPTIC TANK or CESSPOOL cif R 1 7999 Town Clerk Southold Permit No. Fee $ DATE 3/iAt9 APPLICANT NAME: Er; K (1— /Yeker-gtSso.9 APPLICANT ADDRESS: PO 48-1c. iVVg►/l SEPTIC CESSPOOL ‘,"- DESCRIPTIOpl OF PROPOSED CONSTRUCTION OR ALTERATION /1/60 / � s LOCATION MAP: Must be attached hereto before permit may be issued. LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: OWNER OF PROPERTY: 5.;IG J P c3r,o , OWNER MAILING ADDRESS: Pc) gc,,c /q(/ J..,. -C i ,v‘/ / ? / OWNER PROPERTY ADDRESS: f'/S 7( ,A/ t4-, Z4,/ ri, f2J S_y.140fc N ! !!! 1/ TELEPHONE NUMBER OF CONTACT PERSON: 73Y-GG/..S/— TAX MAP NO. : Sect n 07/. 00 Block 03,00 Lot off. e� CROSS STREET: L?� BUILDING PERMIT NUMBER CROSS REFERENCE: i nature of Applicant RECEIVED BY. 400 Town erk's Office DATE: 31 f 1' ...,},Y ;:•a t�lfat Mi add! s s al s a .0 .'=y,as G" s N oury . a+ c q :t.: ::, ^! A , ' 4 • r Kr rri*'" t101Y N71f�,3.A 2. of the `Y original al 1f thi survey SURVEY O F PROPERTY .�.,;°b. considered to o< valid trui NOW of AT BA�YV I EW, TOWiN OF SOUMOLI, 'Certifications indicated h.rsOn sli it that thi. • F SUFFOLK COUNTY, NEIN YORK slaws; OadoIr .d in sco rdsne. with tna :Pi 10 Ina isw rork to AAssoocci Surveys fessiionaltanAqO�� Sq6 R� y tY td v.yOro. Said certifications shall run only ` t , to Tin gron for i on rri.f whoa the titttutcan°aDi�yt.d°herson. ano 7 WF SUFFOLK COUNTY TAX MAP NUMBER —'©— iia;'.";anatt'ti ners' 1s t0'".°ca"i"tio institution. �� • 1000-079.0.0-0300-015000 or suM.W+.nt owners' k'k o GUARANTEED TO: ERIK BOERGESSON E. TEST HOLE oJENNIFER BOERGESSON MCDONALD GEOSCIENCE , ,, CD SURVEYED JULY 23, 1997OWN g•} S`` w 0oNO*iyAl oq HEALTH DEPT . INFO. ADDED AUG. 6, 1997 PALE sANoYRLOAM OL .,..- ,.....- 1 . ?I. 2 �� eSckFRgMFR� y LOT AREA = 22, 359 SF — — — ggpWN LOAMY cyF s h'IFE• Cl. 51 ACRES SAND SM tie — — --- c...2° ELEVATIONS REFERENCE — — — u 3 o '*e>> Q S6g . ASSUMED DATUM _ 400e R 0co9 \ 3� 3 — c / \ 447 Q �t�o OJ ^• res N r, O % Se ..i Den90 e1 U . �]/ i • /o `�C Hp�F ` • S3 • BROWN AND 7 / / i \ SO . \ �• ` �� ti �0 - 6 FIPANE BROWN MEDIUM /�c O \ J o' S2. _, SAND SP .c / ...S:.---44 . n1 S \ ' �i O ® C V i •(L .... t\ °ROp \ L,F� ti .4 . FRS yF nJ Y t/ • z`v co / ' SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES pn ,& �� 17' I "°21• 1 to t o PERMIT FOR APPROVAL OF CONSTRUCTION FOR A t, r IEZ , = SO • i',..? 50 , ti �hN o1NGLrE FAMILY RESIDENCE ONLY 1 `�0• 0 • ` 121 ' f~J 3 SS. AZ"I• • HATE f k- 1 Q 7 HS NO X M -q�7 - 01�13 O O� , ! oDoJ°� aD: 0 : CO .',/ APPROVED T �j s � o,.tp°"dr N / '0.. S c FOR MAXIMUM OF a_BEDROOMS .o O o \ N66 '3g .3 / tiro 304 EXPIRES THREE YEARS FRUM DATE OF APPROVAL {y o� \ \ No 1 • 06 ' Cho. ,~�Q r�of NE (0* FC 06"pki oq A-- / m� (� �����.N c Eh� �°�A,� ;gip \ L INS Oq C• p0,�o q�y �o �o .,-,:.-,- .p�, ��C�IOTOSkI 6 h � * (Y�sr�`,` b egSSkl CP ,v ►�� %': 6MENT < ..�_ - Received ) � °�"'`-�• O� •' Suffolk County C GRAPHIC SCALE 1 "=40 ' •� �:1�►*. !_. Y. S. LIC . NO. 50202 ' AUG �0� JQ �'� =►'T''' LAND SURVEYOR (V 4 6 T MAIN STREET Dept.Of Hea ervices ACAN ) R `VERHEAD. N: Y. 11901 Office Of Wastewater Mgmt.Q 40 80 120 T 3.9-8288 Fax 369-8287 ,. AZ3et'