HomeMy WebLinkAboutJohnsen (3) 0441%°,4,4174:‘,.„..
Town Hall, 53095 Main Road
- �.
cam® ®` �',t P.O. Box 1179
‘, ti �� ���! Southold, New York 11971
JUDITH T.TERRY _at—~,,ve r- FAX(516)765-1823
TOWN CLERK TELEPHONE(516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 470 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : JOHNSEN, ROBERT
Address 1 : 4300 SOUNDVIEW AVENUE
City St Zip SOUTHOLD NY 11971
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.
Name Of Owner JOHNSEN, ROBERT
Mailing Address 1 4300 SOUNDVIEW AVENUE
City St Zip SOUTHOLD NY 11971
Property Address 1 SOUNDVIEW AVENUE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 54.00 block 6 lot 2.002
Cross Street HICKORY ROAD
Building Permit Number Cross Reference:
Issue Date: 2/28/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
L- c.�E-a,lJ E
Fr; 2 31989 Vit { CTowt, g
. ti
BLDG r r k
OF r era r �.x,r Town Hall, 53095 Main Road
UTHOLD � � t<' �
�� 3 �
,,,,%.6%)�•� P.O. Box 1179
��► Southold, New York 11971
JUDITH T.TERRY -„oma TELEPHONE
TOWN CLERK (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
To: Victor Lessard, Southold Town Building Department
From: Linda Cooper, Southold Town Clerk's Office
Dated: February 23, 1989
Transmitted herewith is a copy of application No. 479 for a Cesspool/
Septic Tank Construction Permit submitted by:
Robert Johnsen
•
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: ca.% c. a di. ty
Aff.. Q.4) . .
7
FEB 2 a 19)-.i Signature
Dated
OFFICE OF THE TOWN CLERK c0FD(ir
ef
Town of Southold �,
yo, . ` ��: Application No. Gil?
Town Clerk - »� � `���
, Judith T. Terry, �. � �
Town Hall, 53095 Main Road r � Construction v
P. O. Box 1179 : ; J -
` _, ® Alteration
Southold, New York 11971, .
Telephone *0 ' &' 6-9- Residential V
(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 a 3 — g %
APPLICANT NAME: l\dAe2CJc. s eve"
APPLICANT ADDRESS: 4 3 '(:: Soc,14.o1I;eA-v-e-
SEPTIC (/ CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
ysle01 Aka) hiocfse
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: R
OWNER MAILING ADDRESS:
OWNER PROPERTY ADDRESS: gv p,SI V;eLL/ u 2 SocRad
TELEPHONE NUMBER OF CONTACT PERSON: 76. 5-//GS
TAX MAP NO.': Section (SBlock G Lot p0
CROSS STREET: , ' �
BUILDING PERMIT NUMBER CROSS REFERENCE:
(/'
Signatu of Applicant
RECEIVED BY: Oc�yc, .
eTTirVtlk's Off ce
DATE:
FEB 3 ins
So td Tows o
s . ', 1
SUFFOLK CO, HEALTH DEPT. APPROVAL
. . .. ' . Pa t - ' . ... , a '' H. S. NO.-RH-7-M:2-1.40
E
It
-- STATEMENT OF INTENT
. S. 38 e 'a—
"'---' , & t .,,dr
`3Q- • ' .38. TCJ ` 9 ,�Q_Lam. • -- - +
:THE WATER SUPPLY AND SEWAGE DISPOSAL
• - 3�pf`� ` 5-,-4 .-4-9 - 60.0¢ I - SYSTEMS ` EOR THIS • RESIDENCE WILL
i • r'" �. I ^ Q CONFORM; T• T E . S ANDARDS OF THE
_ ' it r,,,- AWA c7P �% / ��P ' SUFFOLK Cry. r/- • EALTH SERVICES.
•`-�+i Z ° _ • S�r Ems_ r (S)
. i - \ - - O - -
(� �- Al•-LICANT
POZ3ER 7 W
a .,\ �. SUFFOLK COUNTY DEPT. OF HEALTH
(1� �� r r 7+ SERV 1`CES —'FOR APPROVAL OF
c `� CONSTRUCTION ONLY
t _ -_". s Q �---- - _ —__�_._.� �� �'.�i�a ._ 0c_-17-140 4 Q,. �f,- DATE:
•
,� - j N. _t' H. S. REF. NO.. 88= - .r_,----
t _,• c-,.• -- - $r3P: r
- �� I --k34:. �ra1 sefzt'ic a- - - - /9�'+ - - •� ' APPROVED:
ef! s� • '•- _� 4. •J� SrOOL- - SUFFOLK CO, TAX MAP DESIGNATION:
- ' -i' N. v, _ _ DIST. , SECT. BLOCK PCL.
DQd -
_ . �,. ,_ O :�' F 'p is o? �" i'c�JG+`�.1 .. S Q £ OWNERS ADDRESS: _
t : , is ' ' ,' v"a. r=te - _ : , .�o74/742 , Al_ ;�!' /4977
r, _-_ -�.� Oro! A'' .- / rf f�f 7'C' re Z r.� ;,...
i i' DEED: L. - P.
j `_ _ ! v, - ' , ; . TEST HOLE STAMP
•
`: a ' }y, ~ p -1-----
_ � 3- am1(201st
r . •
` . , _, . .. . _L, , ...
...„ __„
�i .�t�Y r ;L ;
° ' . /' ,,a in,io sa;evor'N Irecso seas-
=` !~I.L:: =: _ c a a vci�d v sheik'not ne a nsEr
_ 54 rid it „e copy,
= TEUslty�.j� sesrP indicated here n ::
• __ _ _ _ ins ntees o syr'
- - - , ; , • c. _ ( .. V f C��� !s n prepared,persono the for whom the sun
Y end on his behalf to:`a
moi.."- %1 a ',zee cosr h%governmental a.,er+y a.a)
i _ • - - • ` rvr institution hated ha:aon „3
_ ?a'e osa. pees of the loadingir._,.:-
- - . - = - - Y •::s.::ian.�uarartsas e�® ''.
�Gt E not trabi4cr�.:+3
J7-�LtY.a She:, lyl � �,�i�l'- E' '7 �h C�,ij�� y '•k asi nss'�t>Jtionaarsutrs7usnt
c- ! �; e. -,,,t- ��1" 7�:/k:,,,-.:67,0-`407 •'/ • . e te, -.., tri,d L..41 , L, C"1�45: L - , - 4
- ''�e3R,le 5& w i - ' - 4 _ _- _ , _ - U F _ F,y AL
Ur - --.,- --- -14,- - -
•
1, - .�s• - - -
t _ *
.,t`
_ •t
'FAY
f t
+7
- 4.t ,....'"_•_i"'-_-'-':
9 cO (c,'
_ ".•rill - _- - - '✓
♦� Y
r - 'a� -r
, n0- -E I a
- - • 'V� . S
.'
2
• J
JS
:fir
y
.a
•J
r'
"4
•
•S--
'S l
n S LAND E
REENPO_R,T NEW_YORK . _ >. _ •
- , - -- - • -
- .
F,.