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Town Hall, 53095 Main Road
r;lkO � P.O. Box 1179
„® Southold, New York 11971
JUDITH T.TERRY 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. 565 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : JOHNSEN, SCOTT
Address 1 : 4100 SOUNDVIEW AVENUE
City St Zip SOUTHOLD NY 11971
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILY DWELLING WITH SANITARY SYSTEM.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES ON 4/21/88.
Name Of Owner JOHNSEN, SCOTT
Mailing Address 1 4100 SOUNDVIEW AVENUE
City St Zip SOUTHOLD NY 11971
Property Address 1 SOUNDVIEW AVENUE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 68.00 block 5 lot 3.000
Cross Street MILL LANE
Building Permit Number Cross Reference:
Issue Date: 11/08/83 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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TOWN OF R ,''*a > ,�f • Town Hall, 53095 Main Road
` `��`t,, - "4®�-�• P.O. Box 1179
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JUDITH T.TERRY " ' ,..,;,,,,_1 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: October 30, 1989
Transmitted herewith is a copy of application No. 580 for a Cesspool/
Septic Tank Construction Permit submitted by:
Scott 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.
ELc--1
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: Citd, t_z&s..% ar, ea
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Signature
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Dated
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{='' OFFICES OF.THE TOWN CLERK , cl\FFOCA1(SI.;
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•
Town' of Southold . • �� OG= (�
. ,. y` = Application No.
..„„ , . y •Town Clerk
',,�;,•:,�;Judith T. Terry, 'C •
•`' . }ti„}Town Hall; 53095 Main Road ` • Construction
P. O. Box ,1179 $'
'3 ,,”' -Southold, New -York 11971 • .1”
Telephone Alteration
1°1 44 '1 , " Residential
,�
(516) 765-1801 - - Non-Residential
- TOWN OF SOUTHOLD
• - SOUTHOLD WASTEWATER DISPOSAL DISTRICT
•
w - APPLICATION .
• `' - for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. •
•
Fee .$ /b , 0- 0
• DATE OCT` ff:%
•
-
• APPLICANT NAME: ,/j 0002/2 slen_
•
APPLICANT ADDRESS: ymG �Gvdvi�ri ah,e ..S'cye/>9:7 ✓ ivy
• 1/17/
- SEPTIC CESSPOOL "
'DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION Ne — //t%& '
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
/OWNER OF PROPERTY: craij j®h seil
OWNER MAILING ADDRESS: y/00 Ove
Ny /197/
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: 7615`..5g7/ .
TAX MAP NO.': Section 06( Block Oct Lot /3Q '00
CROSS STREET: $ Of a iwc.. easT or nil// L-
BUILDING PERMIT NUMBER CROSS REFERENCE:
•
'r.nature of Applicant
,. RECEIVED BY:
Clerk's Office• -
- • DATE:
OCT 3019 -
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