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Home My WebLink AboutChausen ,�" .:40FFO`,r ELIZABETH A.NEVILLE ;�� Town Hall, 53095 Main Road TOWN CLERK 1 ® - P.O. Box 1179 cea REGISTRAR OF VITAL STATISTICS W i Southold,New York 11971 ® V 11 Fax(631) 765-6145 MARRIAGE OFFICER 4 `. 11 RECORDS MANAGEMENT OFFICER n..44, �Q 6,• Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER ��' southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 30590 R Residential x Non-Residential Fee $ 10.00 Septic X Cesspool PERMIT ISSUED TO: Name : ARTCO DRAINAGE CORP Address 1: PO BOX 1132 City St Zip MATTITUCK NY 11952 Descripton of Proposed Construction or Alteration ADDITION TO EXISTING SYSTEM. APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES. , EXCAVATION INSPECTION REQUIRED. Name Of Owner CHAUSEN, GUSTAV Mailing Address 1 PEQUASH AVENUE City St Zip CUTCHOGUE NY 11935 Property Address 1 PEQUASH AVENUE City St zip CUTCHOGUE NY 11935 Tax Map No. section 110.00 block 6 lot 1.000 Cross Street GLENWOOD ROAD Building Permit Number cross Reference: Issue Date: 7/29/03 Elizabeth A. Neville Southold Town clerk (TOWN SEAL) 4. t. oma; ELIZABETH A.NEVILLE ��'_ # ; Town Hall, 53095 Main Road TOWN CLERK o - P.O. Box 1179 ti rri 2 Southold, New York 11971 REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER `%\#* � �, Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER _ Ql -0„.�0�� Telephone(631) 765-1800 4. FREEDOM OF INFORMATION OFFICER .. ��' southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 30590 R Residential X Non-Residential Fee $ 10.00 Septic X Cesspool PERMIT ISSUED TO: Name : ARTCO DRAINAGE CORP Address 1: PO BOX 1132 City St Zip MATTITUCK NY 11952 Descripton of Proposed Construction or Alteration ADDITION TO EXISTING SYSTEM. APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION INSPECTION REQUIRED. Name Of Owner GUSTAV CHAUSEN Mailing Address 1 PEQUASH AVENUE City St Zip CUTCHOGUE NY 11935 Property Address 1 PEQUASH AVENUE City St zip CUTCHOGUE NY 11935 Tax Map No. section 110.00 block 600 lot 100 Cross Street GLENWOOD ROAD Building Permit Number Cross Reference: Issue Date: 7/29/03 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) 300 ELIZABETH A.NEVILLE toti"Z° 4 Town Hall, 53095 Main Road TOWN CLERK p A ; P.O. Box 1179 I co, Z $ Southold, New York 11971 REGISTRAR OF VITAL STATISTICS ; $ Fax(631) 765-6145 MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER ` Telephone (631) 765-1800 .4 a0./ FREEDOM OLINFORMATION OFFICER =?®'{ ilii �%I'I1 southoldtown.northfork.net i F I is r, ,---, -i , i --...„-,0 ' ' t E OFFICE OF THE TOWN CLERK t;„ r 'jU N 2 0 2003 , i TOWN OF SOUTHOLD 4 c_ h COLD TO: Southold Town Building Department FROM: Linda J. Cooper, Southold Town Clerk's Office DATED: June 20, 2003 Transmitted herewith is a copy of application No. 3186 for a Cesspool/Septic Tank ALTERATION Permit submitted by: , Artco Drainage for G. Chausen 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. Linda J. Cooper * * * * * * * * * * *; * I have reviewed the application and location map of the project cited above and make the following recommendations: / APPROVE V DISAPPROVE Comments: Maintain required setbacks from adjacent wells,buildings,property lines and water Bodies. EXCAVATION INSPECTION REQUIRED. . Y .__77,161176 --- ' )//"6".....e" 4"41" Signature 61 fi3 /3 Dated ,,,iii. ,,, ELIZABETH A.NEVILLE 114%.. ` • -ct% Town Hall, 53095 Main Road TOWN CLERK q - :` P.O. Box 1179 REGISTRAR OF VITAL STATISTICS �y. 17 �$ Southold, New York 11971 •• - • • • MARRIAGE OFFICER • $ Fax (631) 765-6145 RECORDS MANAGEMENT OFFICER %��f� �o�i��l Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER = '! ,�� southoldtown.northfork.net OFFICE OF THE TOWN CLERK RECEIVED TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT JUN 2 0 2003 APPLICATION ✓ q q0 Southo d Town Cleric CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANK Residential @$10 'or Non-Residential @ $25 Application No.2 tl W, Permit No. Applicant Name-Pt r4Q C GO V1 M C Applicant Mailing Address `QC's \ 13 2 fto---"tt `Y\ 11Rs Septic Tank Lor Cesspool P P Brief Description of Proposed Construction or Alteration - OMcib'YN 15T rt9 c(AS4.6,,V Location of Proposed Construction/Alteration: Owner of Property: Amok, C' user - Owner Mailing Address: `. '.-itRU O, h -k-cJA0v.e____- % Oct 3 S- Owner Property Address: Name and phone number of contact person Tax Map No: Section 1 1 7,► 0® Block O(o.00 Lot 1 ,0 00 Cross Street ?eQIy,0.5 (1Ne-61 0300 erA NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL G,--ZD-63 Signatur of Applicant Date Received by: Q ; c_) 1c• ") 3 .q J w ti 9.1 CC . c)k4. r p ' w R _ ' . 1 % 0 61 c3 74% N ' NA a.sib - n .N. V oN a . , . 0 z 013*4 • klit -Tea,17 31 A i N u` IN akU z g-6-6 2°.G /•o N 0 '- '0 nay cn'a N' l % lof WN - v o� . 1 0 � a.�as � Na ; 0 _ 4 Fir i ' %,--ra.sytrer --p-x0-14)-S /4.98/ '1,? ,ill o er4- -P . ' )-19-0).0-mt. ga BG � ' � u1v�s ® . � - - _511P°0_-__ -PN - -- 51-1-�. h M, - o sl - -Tion ,sasno - " 6 ,4 4vE,t/L/E �- SURVEYED FOR:-C..3[1.5 741/E A. L L4CJSEti/ LOCATED AT C'v7-e/7 , TOWN OF , SUFFOLK COUNTY N.Y. ' F i LOT / i% 0 • MAP OF f ..e.oPE,€7y oc .Q4V47O / ,PE.4 7 C-oQ,Ple,•e,47/o(/ , CO. CLK. NO. 5.39 FILED pEC.Z2, /.95 SCALE 1" =30• SUFFOLK CO. TAX MAP DATA:- DIST. /000 , SEC. //O.2 BLK. O6.00 LOT 00/.000 OFFSETS FROM STRUCTURES . TO RELATIVE BOUNDRY LINES, ON SURVEY, ARE FOR A SPECIFIC USE ONLY, AND S 7OUTE/ ,Q J G €O4® SHOULD NOT BE USED FOR 1) ,�J574J�' DO"E CONSTRUCTION OF FENCES /99.450 OR OTHER STRUCTURES. L 13 WN I U Mw � o y -39.5 i 30.z iit D ^w ,v* aw.c.c_ 1 SToe 01 I-1 rb "4N \._. 5,7.4O pc/ELGNFa. Z 51 m o �,oeq Cet et Swao4 e , re 37-Z \co �O .2. 111 176.1.61 c /.4.e44J E6.� o • S�/ 09 `lam(/ H:V° "1°o t T GUS 7-4 t/E A. �'C 4USE-41 /.9.9 ,90 � P,o z 1B4ZCC4 yS .BAve o/r-�A./ k/y' e,e SURVEYED ,4P,e/L /i 1989 BY WILLIAM R. SIMMONS JR. P/O BOX 377 ! % �„ JAMESPORT, L. I., N. Y. 11947 FILE NO. /2 220 PAGE 23 GRfD.J-39 DRAWN BY �7`�' jC'�,� - ,/ '