HomeMy WebLinkAboutCarlson (2) SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4365-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner LYNNE CARLSON
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Mailing Address 1 18 SOUND ROAD
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Mailing Address 2
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City St Zip GREENPORT NY 11944-0000
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Property Address 1 SAME AS ABOVE
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Property Address 2
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City St Zip 00000-0000
Owner Telephone No. 631-477-4220
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Tax Map No. section 35.00 block 1 lot 17.000
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Cross Street ROUTE 48/ROUTE 25
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Issue Date: 12/06/07 Elizabeth A. Neville
------ Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE �� Town Hall, 53095 Main Road
TOWN CLERK � = P.O. Box 1179
REGISTRAR OF VITAL STATISTICS O Southold, New York 11971
MARRIAGE OFFICER '1ijf o!`� Fax (631) 765-61.45
RECORDS MANAGEMENT OFFICER o! `�►� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net
OFFICE OF TIIE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
OPERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @ $10 /or Non-Residential @$25 Application No. I��
Permit No. 3�J
Owner Name ��++
Owner Mailing Addr ss IS �7et1,uDA�
Owner Property AddressQ-yy.D
Owner Telephone No.
Tax Map No: Section Block 11Lot
Cross Street L' of
Please check each that applies: New Construction /
Alteration to Exists ystem 6&C*"_._k
Residential V Non-Residential
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. (Locate
building and system; give north arrow and approximate distance in feet from system to building
and closest road. New construction may submit copy of survey with SCHD approval.)
ills
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Si *ae f Applicant Date
Received by: 1 a'I(O
a
COASTLINE CESSPOOL & DRAIN SERVICE
4225 Bridge Lane
Cutchogue,L.I.,N.Y. 11935
631-734-6585
SCCA Lic. #168-LW NYS DEC#1A-600
200Z
Re: 720e4/e
Upon inspection of the septic system at the above-captioned
address, the following was found:
• ( x Gallon Septic Tank NEVI
• x I ZZ Leaching pools N E W
• Piping and tee condition: tsi Fw
• Current system capacity: >`
• Condition of system:
If you need additional information or have any questions,
please feel free to contact me.
Thank you,
2 of
O O William W. Park
President
38, 34
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LOT 22 `h
LOT 24 N/F
NSF ZORN
JEM REALTY CO.
_ FND S27'4_7'30"E _
- - 70.00'
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10.1FRAME (r
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16.0' �.
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LOT 16 CD 00 NSF
NSF N M HEINS
SINCLAIR N V-
W 13.0' 10.2'
WOOD o
DECK
20.0' 4-
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33.0' 10.2'
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70.0_0' 313.21'
rN27*31'20"W
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SOUK® ROAD
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CERTIFIED TO:
I LYNNE CARLSON
INDYMAC MORTGAGE HOLDINGS INC.
FIDELITY NATIONAL TITLE INSURANCE
COMPANY No. FNT9922969
field aan: P,Q*t Na:
LCT AREA - F►1H p`5C s9-03 LYNNE CARLSON
I — Dra.nBr. Ora•' Nana,
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in n7R+ q PP'I-T fMH CARLSpN.DWG
ELIZABETH A.NEVILLE OrjF sUuryOl
Q Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER �� Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER COUNTI,� 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. 3591 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : LYNNE CARLSON
Address 1: 18 SOUND ROAD
City St Zip GREENPORT NY 11944
Descripton of Proposed Construction or Alteration
-REPLACE EXISTING BLOCK POOL TO PRECAST (1000 GLS SEPTIC & 8 X 12
OVERFLOW POOL)
-MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS, BUILDINGS, PROPERTY
LINES AND WATER BODIES
Name Of Owner LYNNE CARLSON
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Mailing Address 1 18 SOUND ROAD
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City St Zip GREENPORT NY 11944
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Property Address 1 340 SOUND ROAD
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City St Zip GREENPORT NY 11944
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Tax Map No. section 35.00 block 1 lot 1.700
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Cross Street ROUTE 48/ROUTE 25
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Building Permit Number Cross Reference:
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Issue Date: 10/26/07 Elizabeth A. Neville
-------- Southold Town Clerk
(TOWN SEAL)