HomeMy WebLinkAboutJohnsen (4) OFFICE OF THE TOWN CLERK c.OFUL/r`,
Town of Southold �Q
Judith T. Terry, Town Clerk . #•.
Town Hall, 53095 Main Road • a .; , •
P. 0. Box 1179 c.r3
Southold, New York 11971 ‘V6,.` 4 , 0�..
Telephone ol •
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 228 Residential
Non-Residential
Fee $ 10.00
Septic Cesspool X
PERMIT ISSUED TO:
NAME: Robert Johnsen
ADDRESS: 4300 Soundview Avenue
• Southold, New York 11971
DESCRIPTION OF PROPOSED CONSTRUCTION or ALTERATION
New Single Family Dwelling with Cesspool System
APPROVED as per Suffolk County Health Dept. approval
LOCATION OF PROPOSED CONSTRUCTION or ALTERATION:
OWNER OF PROPERTY: Robert Johnsen
OWNER MAILING ADDRESS: 4300 Soundview Avenue
Southold, New York 11971
OWNER PROPERTY ADDRESS : ROW off County Road 48
Southold, New York
TAX MAP NO. : Section 69 Block , 1 Lot p/o 4
CROSS STREET: County Road 48
BUILDING PERMIT NUMBER CROSS REFERENCE:
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Judith •-T. T rry •
Southold Town Clerk
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DATE : September 28, 1987 f`{
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"R. ` C $ Town Hall, 53095 Main Road
e���� , P.O. Box 1179
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JUDITH T. TERRY • ''-""iil��� TELEPHONE
TOWN CLERK (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
September 28, 1987
Robert Johnsen
4300 Soundview Avenue
Southold, New York 11971
Re: ROW off County Road 48
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)
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VCOFOLit .0
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abt.` .' Town Hall, 53095 Mall Road
BLDG DEPT. f '.--t` ..%` 0
TOWN OF SOUTHOLD -1. tf,� 1E1 �+ + P.O. Box 728
- �,t,�� �,,i+r+ Southold, New York 11971
iuurriI T T1 RRY TELEPHONE
TOWN( I I R). (516) 765-I81I1
RrcIsTRAR or vim!,srArlsrlcs OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
September 11, 1987
To: Victor Lessard, Southold Town Building Department
From: Judith T. Terry, Southold Town Clerk
Transmitted herewith is a copy of application No. 230 for a
. CONSTRUCTION or ALTERATION Permit for a cesspool or septic system
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 we may issue the permit.
Please complete the form below and return it to my office.-
Thank you.
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v, .A :r5', o t , , , ....v..
Judith T. Terry
Southold Town Clerk
* * * * * * * *
I have reviewed the application and location map of the project
cited above and make the following recommendation: ,
APPROVE - 7C
DISAPPROVE -
COMMENTS: g • . '�. 4
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Signature
9.\ZA\\I i 1
Date
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OFFICE OF THE TOWN CLERK c0Fa
Town of Southold 4 Application No. c2'dp
Judith T. Terry, Town Clerk ;
Town Hall, 53095 Main Road„ , ° Construction _
P. O. Box 1179
� ;'• Alteration
Southold, New York 11971 ��-�,
Telephone OI i 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 $ /Q
DATE q- /5- S?
APPLICANT NAME: ,Jkob.e, ( - ,
APPLICANT ADDRESS: 4300 Sobudv,'P Ao e
SEPTICCESSPOOL l/-- -
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
Ate„ /S7ovs P
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LOCATION MAP: Must be attached hereto before permit may be issued.
•
• LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY:
�?� fed h s e
' OWNER MAILING ADDRESS: ( 3 c cJ S o i,,,,J,,,, (>44 - / rid Sjo e-%-
OWNER PROPERTY ADDRESS: iR(:) , .. `/4
TELEPHONE NUMBER OF CONTACT PERSON: 76 c”-//G 5
TAX MAP NO. : Section GC y Block / Lot lv
CROSS STREET: LIr n
BUILDING PERMIT NUMBER CROSS REFERENCE.
%r, / ,• ' ,
l Signature ,of Applicant
RECEIVED BY: -c% ( _
Town Jerk's Ifice "
DATE: 9— .//-
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