HomeMy WebLinkAboutTorkelson (2) 4. '�fifLfT[L '////• i"%I ,
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JUDITH T. TERRY ;
4ratr � P.O. Box 1179
TOWN CLERK , `-3 1 Southold, New York 11971
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REGISTRAR OF VITAL STATISTICS ' � y
MARRIAGE OFFICER ‘1,eb&Itgb:kg.Aj Fax (516) 765-1823
Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 783 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : TORKELSEN BUILDERS INC.
Address 1 : P. O. BOX 1475
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 ON 11/15/91 .
Name Of Owner TORKELSEN, LARS
Mailing Address 1 P. O. BOX 1475
•
City St Zip SOUTHOLD NY 11971
Property Address 1 1130 GLENN ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 78.00 block 1 lot 31 .000
Cross Street MAIN BAYV I EW
Building Permit Number Cross Reference:
Issue Date: 12/05/91 Judith T. Terry
Southold Town Clerk
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JUDITH T. TERRY t. I , F5�3,095 Main Road
TOWN CLERK 'E�VQ�sV 4J...P. �` ox 149
REGISTRAR OF VITAL STATISTICS v i .�� Southold, New York 11971
MARRIAGE OFFICER N, ��' Fax (516) 765-1823
� s� �q�®r,�- Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
To: Southold Town Code Enforcement Officer
- From: Linda Cooper, Southold Town Clerk's Office
Dated: December 4, 1991
Transmitted herewith is a copy of application No. 807 for a Cesspool/
Septic Tank Construction Permit submitted by:
Torkelsen Builders Inc. for Lars Torkelsen
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.
cv-c.."..__x_ctc.._ .9 e_e__a_pa jj
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: co.o , .v.S.l:Jeatigt.. u n Garay—Oak. Z,uh,.a.1
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REC Signature
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AOI FICE OF THE TOWN CLERK ,,,'"""
Town of Southold .0"ctFake
Judith T. Terry, Town Clerk ��' cl/y'� `
Application No. '67
Town Hall, 53095 Main Road � Construction
P. O. Box 1179
Southold, New York 11971 t1'� �� Alteration
Telephone ,- ,`'O �0�,' $10.00 - Residential
(516) 765-1801. = 1 .,,4g ,, a $25.00 - Non-Residential
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
• SEPTIC TANK or CESSPOOL
Permit No.8-0 •
Fee l
DATE l '03 /59
APPLICANT NAME: / D(JZ ESS oU 63 UJw 72J 4 rV c
• APPLICANT ADDRESS: P O . C6 . (P
So v.7 44oL0 ( )-u r j ) 571
SEPTIC �ESSPOOL%--------
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION -ru Cd
sYsit w'
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: 1 /IRS Jdl2KE1-541
• OWNER MAILING ADDRESS: 113o GC CPU ft) Rte.
Sou
7/4oL (6 . \/. ) 157/
OWNER PROPERTY ADDRESS: /)3o 6-4Crvry 12 b
5o urn-foto.
TELEPHONE NUMBER OF CONTACT PERSON: ?C ` .1 et eC
TAX MAP NO. : Section 7 S Block ) Lot 3/
CROSS STREET: �' ,1 �dU �3$YUJe-
e
BUILDING PERMIT NUMBER CROSS REFERENCE:
1;,%e
Signature of Applicant
RECEIVED BY: - 11!' Imo,
Town Clerk Office
DATE: / ./ -$2,/
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C.
SUFFOLK CO.HEALTH DEPT.APPROVAL
AL
1. y,+(1 'SP00cs / - - - „ H.S. NO.
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~" 3 4 , - .St'r<vE`?E 9 POrZ C�y' " ,`S •��� / ZZO�� WELL COVENANT REQUIRED ;F
, �o �e L 125 ' -�-�-����� ��E PRIOR TO FINAL APPROVAL.
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O - Ar STATEMENT OF INTENT
\ '0 o r_F i ,);l.-{ I cI THE WATER SUPPLY AND SEWAGE DISPOSAL
� E. �"' �Q�' o cCipp Or 8 uspoo r�r —r, ,x SYSTEMS FOR THIS RESIDENCE WILL
-�w�.t1 8� 43.0 F CO• /yAP — ' CONFORM TO THE STANDARDS OF THE
- --�y.1.., 'w.'�.�C FLA'PJs t-1 `��` ��tQ 6V l P SUFFOLK E T HEALTH SERVICES.
1 �` =g f D2XEGSEW Q3uluortes rvG
0 , ��� . Po 60x A/7f (S AP ICANT
R I ' 1.7_ `� tN , SvuTNoLO/N*� ��571 SUFFOLK COUNTY DEPT. OF HEALTH
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SERVICES — FOR APPROVAL FOR
! ? -` i \ ���� ~ - CONSTRUCTION ONLY
i DATE: I �.
n ' H.S.REF.NO.: i tS O �
?' u� I ! $ �°�� APPROVED: v Tom; L1 /
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I 9 ' J I ��(RV�C�S SUFFOLK CO.TAX MAP DESIGNATION:
'R1 SG��5� DIST. SECT. BLOCK PCL.
I I i 0. 1000- 78 I 31
I (VACANT)
I, i ! ./ ( } _ OWNERS ADDRESS: .
I
I t30 GLENN
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� 'I SUJ�•HJLDJY 1
1971
!I r 3.MONUMENT
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I = F{P (TEL.-te5-3)74)
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!� -_L__ -.;3 I /,IEA=_22,889 5.F DEED: L.t•S/A P. I
I >- I [r +� • TEST HOLE STAMP
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Ii elf t!'� E FAMILY' DWELLING ONLY - �,T
,5 , R j-w°� I EXP RES1"WO-YEARS FROM DATE OFAPPROVAL .. - - -- - 1 . ;, b9N.,�nnr '
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ll ' 'duca;fon Law.
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d Tv MAP OF E'ST 12E.r lc EFITATE. FI CZI TNT. to Lie a mild truo coo.
+' G?Eh+N ROAD O. f)' , $H[ SVFF CO,CLI:RIk'5 OFFME F,5 MAP f10.3Bd8. - t. Guarantees lnGrrted Ferran the!
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RESIDENCE 1 AS S;JIZVEYED JUN.Ig .1gQf _ ¢�
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WELL i ZEPT1C LOCATIONS Nor\- I vim«++-% \\`a<5 296`5%-
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Avp It a ) LICENSED LAND SU VEYORS • - �,=�-
- GREENPORT NEW YORK
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