HomeMy WebLinkAboutVerwayen (2) OFFICE OF THE TOWN CLERK cOFOL1'
Town of Southold
Judith T. Terry, Town Clerk . � '
Town Hall, 53095 Main Road c t„
P. o. Box 1179 . �{ ' �
Southold, New York 11971 O ;; r3 �- ••
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Telephone - c �,
(516) 765-1801 •
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 211 Residential x
Fee $ 10.00 Non-Residential
Septic Cesspool- X
PERMIT ISSUED TO:
NAME: Roger Cullen - Gardiners Bay Construction Co.
ADDRESS: 81 Gardiners Bay •Drive
Shelter Island, New York 11965
DESCRIPTION OF PROPOSED CONSTRUCTION or ALTERATION
New Single Family Dwelling with Sanitary System
APPROVED as per Suffolk County Health Dept. approval
LOCATION OF PROPOSED CONSTRUCTION or ALTERATION:
OWNER OF PROPERTY: Joseph and Doris Verwayen
OWNER MAILING ADDRESS: 29 Duncan Road
H&HoKus, New Jersey 07423
OWNER PROPERTY ADDRESS : Glen Road '
Southold, New York
TAX MAP NO. : Section 78 Block 2 Lot 42
CROSS STREET: Sleepy Hollow Lane
BUILDING PERMIT NUMBER CROSS REFERENCE:
Judith T. Terry
Southold Town Clerk
DATE: August 10, 1987 1 �,
(TOWN SEAL)
slid COFULt
0441
,1 '44,7 $ Town Hall, 53095 Main Road
.� � '"1 .������ P.O. Box 1179
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00
.JUDITH T. TERRY ' TELEPHONE
TOWN CLERK (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
August 10, 1987
Roger Cullen
Gardiners Bay Construction Co.
81 Gardiners Bay Drive
Shelter I slAnd, New York 11965
Re: Joseph and Doris Verwayen
Glen Road
Southold, 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 yours,
• ' ✓ raid
Aga/ 4 '_
Ce
Judith T. Terry
Southold Town Clerk
Enclosures (3)
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OFFICE OF THE TOWN CLERK c,VFFOCA-1,--
Town
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Town of Southold per, t =.CSG . Application No.07/
171
Judith T. Terry, Town Clerk :-, : �G ; pp
Town Hall, 53095 Main Road ` c Construction
Cd'� .rr ,
P. 0. Box 1179 tcs• '%- Alteration
Southold, New York 11971
�_1 [ 1t , , 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. o21( •
Fee $ /D
DATE g 1 IOIq 1 .
APPLICANT NAME: iOck€ `Z Cir\ ev -1EVIGtie-S-S al/6,4L/1•4 co •
APPLICANT ADDRESS: Q Q4jie s fa-avi p-1j(•
\mac \S\14-b 01 /G\/. 1 kCj 4 •
SEPTIC CESSPOOL L7
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
COOlOrrVC-V. S\ \.`t... &L.., e Oweik8 ,,Ays
LOCATION MAP: Must be attached hereto before permit may be issued.
• LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: 1-0. .e_.,0,11/4. QOc 1'S VerW. ta- €A)
OWNER MAILING ADDRESS: (20A, Q`ye C,,--Y0 40 wc,, v,,,‘ M S .0`1443
OWNER PROPERTY ADDRESS: c,`,,,, � w Ld Al
TELEPHONE NUMBER OF CONTACT PERSON: 374 Prq. t '‘<g
TAX MAP NO. : Section ê hn Block a Lot L/ )
CROSS STREET: leCg ') 1lpj-4),
BUILDING PERMIT NUMBER CROSS REFERENCE:
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Signature or-Applicant
RECEIVED BY: 4.(-.-"yLct _J--------+
Town Cle k's Offi yie
DATE: Cr- /d .t--7
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