HomeMy WebLinkAboutJohnsen OFFICE 07 THE TOWN CLERK C..FFU[/f/`,"
Town of Southold � w . --444
Judith T. Terry, Town Clerk �` Y " O.
Town Hall, 53095 Main Road 18 ,, ,+
P. O. Box 1179 .cr3 l "' ' � ,.
Southold, New York 11971 O
Telephone 1 ig[ -,,
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 57 Residential xx
Non-Residential
Fee $ 10.00
Septic Cesspool xx
PERMIT ISSUED TO:
NAME: Robert Johnsen
ADDRESS: 430(1 Snimdview Avenue
Southold, New•York 1 1971
DESCRIPTION OF PROPOSED CONSTRUCTION or ALTERATION
New system
•
LOCATION OF PROPOSED CONSTRUCTION or ALTERATION:
OWNER OF PROPERTY: Robert Johnsen
OWNER MAILING ADDRESS: 4300 Soundview Avenue
Southold, New York 11971
OWNER PROPERTY ADDRESS : 11227 Soundview Avenue
Southold, New York
TAX MAP NO. : Section 54 Block 6 Lot 2.2
CROSS STREET: Booth Road
BUILDING PERMIT NUMBER CROSS REFERENCE: Pendingoree,04;zieec„......."...
Judith T. Ter
Southold Town Clerk
DATE : October 7, 1986
(TOWN SEAL)
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:xy �1�♦ Town Hall, 53095 Main Road
4(: �x - - `C" P.O. Box 728
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JUDITH T TERRY TELEPHONE
TowN CLERK (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
• TOWN OF SOUTHOLD
October 7, 1986
Robert Johnsen
4300 Soundview Avenue
Southold, New York 11971
Re: 11227 Soundview Avenue
Southold, New York
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 ($25. 00) for non-residential.
Please have the owner complete the enclosed Application for an Operation
Permit and return it to this office along with the proper fee.
For your general information I have enclosed an Informational
Bulletin regarding the Scavenger Waste Laws adopted by the Southold
Town Board. Should you have any questions pertaining to either permits
or the Scavenger Waste Laws, please do not hesitate to contact this
office. We will be glad to assist you in any way possible.
Very truly yours,
•
Judith T. Terry
Southold Town Clerk
Enclosures (3)
JTT/Ijc
OFFICE OF-"THE TOWN CLERK
Town of Southold Application No.
Judith, T. Terry, Town Clerk
Town Hall, 53095 Main Road Construction
P. 0. Box 1179 Alteration
Southold, New York 11971
• Residential
Telephone
(516) 765-1801 Non-Residential
RECEIVED TOWN OF SOUTHOLD
OCT 071986
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
T bwr CIrk Southold
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. Lc'
Fee •$ /d °c-
DATE /0- 7- �G
APPLICANT NAME: gipPPTJn ots-e+A
APPLICANT ADDRESS: • �3 vo Su view Au z
SEPTIC i/ CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
/€W
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONST UCTION OR ALTERATION:
OWNER OF PROPERTY : QC)Izie T' To k vt 5 s�,
OWNER MAILING ADDRESS: 4 -3cics So o c
() 1 ) 1i
OWNER PROPERTY ADDRESS: / / 2 Sc3C,uGr V
TELEPHONE NUMBER OF CONTACT PERSON: 76g- /it S
TAX MAP NO. : Section z7C/- Block 6 Lot P® j .
CROSS STREET: c,1401; e �v2 �e'� ( ®tet— 7
BUILDING PERMIT NUMBER CROSS REFERE
• Signatdr of Applicant
RECEIVED BY: C ` dc--i`
Town lerk's O ice
DATE: 6 /. /9,6
i
•
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LICENSED LAND SURVEYORS
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