HomeMy WebLinkAboutMortensen (2) Ili WM&
JUDITH T.TERRY 1� " Town Hall, 53095 Main Road
TOWN CLERK k
� - M P.O.Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS D
MARRIAGE OFFICER 4 4� � i� Fax(516)765-1823
RECORDS MANAGEMENT OFFICER ®g V,-,10 Telephone(516)765-1800
FREEDOM OF INFORMATION OFFICER .���,,,,,• �
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1196 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : NICHOLAS J. MORTENSEN
Address 1 : 1560 BAILIE BEACH ROAD
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
ADDITION OF OVERFLOW POOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS
BUILDINGS, PROPERTY LINES, AND WATER BODIES.
EXCAVATION INSPECTION REQUIRED.
Name Of Owner MORTENSEN, NICHOLAS J.
Mailing Address 1 1560 BAILIE BEACH ROAD
City St Zip MATTITUCK NY 11952
Property Address 1 1560 BAILIE BEACH ROAD
City St Zip MATTITUCK NY 11952
Tax Map No. section 99.00 block 3 lot 11 .011
Cross Street EAST DRIVE
Building Permit Number Cross Reference:
Issue Date: 9/15/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRY : < Town Hall, 53095 Main Road
TOWN CLERK v rag : P.O. Box 1179
in w $ Southold, New York 11971
REGISTRAR OF VITAL STATISTICS • V• O ��� Fax (516) 765-1823
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER _��®1 '' ,,. Fax
(516) 765 1801
FREEDOM OF INFORMATION OFFICER ":�%ow//i//#
OFFICE OF THE TOWN CLERK ��7
TOWN OF SOUTHOLD D ,__ __N _N_ ------'ll__U__. __,
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TO: Southold Town BuildingDepartment '! i
P �, , �, �� it-, 3 6 1994 , ��i �
FROM: Linda Cooper, Southold Town Clerk's Office T ,
DATED: August 30, 1994 BLDG.DEPT
TOWN•F SOUTHOLD
Transmitted herewith is a copy of application No. 1241 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Nicholas J. Mortensen (work to be done by Peconic Cesspool) .
Please review the application and location map and advise if this office may
issue the permit.
Please complete the form below and return it to this office.
Thank you.
—
Qc-Gtw
Linda J. Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the following recommendation:
APPROVE - EXCAVATION INSPECTION
DISAPPROVE - REQUIRED
COMMENTS: 1/_, % , • - ,cif /- e-, /
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Signatur:
9 / 40
Date
OF,VICE 'OF THE TOWN CLERK ,,,,""""%, •
Town of Southold �:�'��C,��F�OIk
Judith T. Terry, Town Clerk ��` _ �c/ : Application No. /fit/
Town Hall, 53 95 Main Road ��Z,`., : j Construction
P. 0. Box 1179 = �4 ` ��
Southold, New York 11971 j, `�.:.` $% � Alteration
Telephone =0,�, Q�''� $10.00 - Residential
(516) 765-1801 ' "..t ! ;, ' $25.00 - Non-Residential
• -.. .. , 00-
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
•
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $ •
DATE
APPLICANT NAME: ,t//e//o/4S -f- 1104 �! ,v s, .rl
APPLICANT ADDRESS: /S-6.0 Eaa4/6e a, &Qat/ ,.v
!a%// %&`ce ..0---, /r' �s
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
•
LOCATION MAP: ' Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: si4e,4;4. .J"7 ,1127",„i_c,.r,'
OWNER MAILING ADDRESS: /c''lhte) /1-#4..e‘1 4- e-4- P-f X9
OWNER PROPERTY ADDRESS: -c.9-� � r9s A-1de.hra'
TELEPHONE NUMBER OF CONTACT PERSON: `r - 9....35-"P :� all
-y 4.7
TAX MAP NO. : Section d9 Block 3 Lot /1.//
CROSS STREET: ,;r 6,e,,. 4
BUILDING PERMIT NUMBER CROSS REFERENCE: /734/5 Jo - /g-8,Es'
` Signature of Applicant
RECEIVED BY: , bit--e4/,---------
own Clerk's Office
DATE: e,, , 5 V
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