HomeMy WebLinkAboutGustavson, Troy ,01 co Fiiure,
%, ' `1 ��ik Town Hall, 53095 Main Road
`.- r P.O. Box 1179
%.14 Jr- 't\'00 Southold, New York 11971
JUDITH T. TERRY " r if40- TELEPHONE
TOWN CLERK _ (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
August 28, 1987
Troy Gustayson
P.O. Box 247
Orient, New York 11957
Re: #7780 Main Road -
Mattituck, New York
Enclosed herewith is the Construction, Alteration or Modification
Permit for -a Septic Tank or Cesspool System for which you applied.
Please be advised that each owner of real property operating an
on-site sewage disposal system, such as a septic tank or cesspool must,
prior to such operation, possess in the name of the owner an Operation
Permit for the system. The Operation Permit is issued by the Town
Clerk's Office.
The fee for an Operation Permit is ten dollars ($10.00) for
residential use and twenty-five dollars ($25.00) for non-residential.
Please have the owner complete the enclosed Application for an Operation
Permit and return it to this office along with the proper fee.
For your general information I have enclosed an Informational
Bulletin regarding the Scavenger Waste Laws adopted by the Southold
Town Board. Should you have any questions pertaining to either permits
or the Scavenger Waste Laws, please do not hesitate to contact this
office. We will be glad to assist you in any way possible.
Very truly ?fours,
eireorease:000,7=000.....0
Judith T. Terry
Southold Town Clerk
Enclosures (3)
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OFFICE OF THE TOWN CLERK ��f OCK`,-
Town of Southold , � �lj
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road
P. O. Box 1179 .r -
Southold, New York 11971 O 't •r ''�
Telephone Wei it •N,,',
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. NR2 Residential
Fee $ 25.00 Non-Residential X
Septic Cesspool X
PERMIT ISSUED TO:
NAME: Troy Gustayson
ADDRESS: P.O. Box 247
Orient, New York 11957
DESCRIPTION OF PROPOSED CONSTRUCTION or ALTERATION
Construction of New Office Building
APRROVED as per change and approval by Suffolk County Health Dept.
LOCATION OF PROPOSED CONSTRUCTION or ALTERATION:
OWNER OF PROPERTY: Joan and Troy Gustayson
OWNER MAILING ADDRESS: P.O. Box 247
Orient, New York 11957
OWNER PROPERTY ADDRESS : #7780 Main Road
Mattituck, New York 11952
TAX MAP NO. : Section 122 Block 6 Lot 29.1
CROSS STREET: Bray Avenue
BUILDING PERMIT NUMBER CROSS REFERENCE: 16375Z
Judith T. Terry
Southold Town Clerk
DATE: August 28, 1987
(TOWN SEAL)
p DG ".
•
• ' Town Hall, 53095 Main Road
O ' 1 P.O. Box 1179
-44:7`�,( "'! I �9° Southold, New York 11971
JUDITH T. TERRY ��� •0" TELEPHONE
TOWN CLERK (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
August 25, 1987
To: Victor Lessard, Southold Town Building Department
From: Linda J. Cooper, Southold Town Clerk's Office
Transmmi�ittedd herewith is a copy of application No. NR2 for an
AONSTR tCT10PERMIT for a cesspool or septic system submitted by
Troy and Joan Gustayson
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.
Linda J. Cooper
I have reviewed the application and location map of the project listed
above and make the following recommendation:
APPROVE - X
DISAPPROVE -
COMMENTS: h4. Qc c.YLOolm.L � P
Signature
Date
Y `I,
OFFICE OF THE TOWN CLERKO`jVFF�CI�'`+D ,�
LAJ
Town of Southold 0' Application No.
W".
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road g Construction
P. O. Box 1179 J Alteration
Southold, New York 11971
Telephone °1 0 Residential
(516) 765-1801 Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 16315 2
Fee $• 7 d� 6t)
DATE c�
APPLICANT NAME: —171-171 G .-5 A. 11
Y&(J
APPLICANT ADDRESS: P` 4' ' 130'
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSElp CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
• LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: I
OWNER OF PROPERTY: U-0/46J ± cVS17 \/SDr`.J
OWNER MAILING ADDRESS: p. 0 Qu y
DP--iG Vt./ I 19 C- ,
OWNER PROPERTY ADDRESS: Hki rJ ( 1"1-1 • 4-7-7
lett nI(me--1') CL(1. I 1'152-
TELEPHONE
ZTELEPHONE NUMBER OF CONTACT PERSON: _1 j --O015' I(U)
TAX MAP NO. : Section [ 1. 1 Block 6 Lot 2-cts
CROSS STREET: ',/4[S) 6F- B ILitm
BUILDING PERMIT NUMBER CROSS REFERENCE: 3 75
Signa u of Applicant
4.
RECEIVED BY :
T• n I erk's O fice
DATE: Ell
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SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
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' ,.---- For Constructisan Only H.R. fief. No.
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sanitary disposal and wn'ff S •')a'y facilities puma&to
Articles VS onfil 7 • -,' '- - '` ilir County SarktarY
' Code for _...42e /e.,e3-_ . _..... —
• 11
and is not ,..i• - -. - . • ., ' '4 . .C1041,311 lit
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.. , -.. • ' -, ., ,- . '-) THIS APP- .
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ROVAL EXPIRES -; A'_: i t,- , - .,; 141E LIA,TESEL_Ow.
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JUN 16 1981 e-P I)4_ _4 Q. 0,gest. p. v-
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DATE SIGNAWI 4.
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