HomeMy WebLinkAboutGaydosik, Mary ,0.14F01.kt.„
JUDITH T. TERRYTown Hall, 53095 Main Road
TOWN CLERK T ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS tri
Southold, New York 11971
MARRIAGE OFFICER O. ��, Fax (516) 765-1823
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711 1D 0'. Telephone 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. 1001 R Residential X Non-Residential
Fee $ 100.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : GARY TABOR
Address 1 : 680 NAVY STREET
City St Zip ORIENT NY 11957
Descripton of Proposed Construction or Alteration
ADDITION OF 8' X 12' LEACHING POOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. KEEP AT LEAST 10' APART. EXVATION INSPECTION
REQUIRED. CALL 765-1802 FOR AN APPOINTMENT.
Name Of Owner GAYDOSIK, MARY
Mailing Address 1 2105 MILL ROAD
City St Zip MATTITUCK NY 11952
Property Address 1 2105 MILL ROAD
City St Zip MATTITUCK NY 11952
Tax Map No. section 100.00 block 3 lot 13.000
Cross Street REEVE ROAD
Building Permit Number Cross Reference:
Issue Date: 5/24/93 Judith T. Terry
Southold Town Clerk
____ _ (TOWN SEAL)
Z .G •: Town Hall, 53095 Main Road
JUDITH T. TERRY z
TOWN CLERK : p T P.O. BOX 1179
REGISTRAR OF VITAL STATISTICS Cr � Southold, New York 11971
MARRIAGE OFFICER ‘%$40:02‘,.i
Q �' �', Fax (516) 765-1823
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1 1 �� Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
1 qhs 2 I
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: May 21, 1993
Transmitted herewith is a copy of application No. A1029 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Gary Tabor for Mary Gaydosik
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.
44,1,,,e,
Linda J. Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the followin recommendation:
APPROVE -
DISAPPROVE -
COMMENTS:
�:1 /IYA INSPEC ION Signature �, �L/ice
y1
REQUIRED f/ 3
Date l
•
OFFICE OF THE TOWN CLERK ,,,'"'"""'
Town of Southold �ele cj�FF��K�'OG Application No.f0
Judith T. Terry, Town Clerk ,, y
Town Hall, 53095 Main Road Construction t__
P. O. Box 1179 _ '
Southold, New York 11971 Vs _
tore. Alteration
Telephone
$10.00 - Residential /0
(516) 765-1801 'y�01 �
$25.00 -Non-Residential
,,,,,,
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE
APPLICANT NAME: ' / i . p �^
APPLICANT ADDRESS: Z, c M/14 //'y j 7
SEPTIC CESSPOOL L�
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
-mss l r it �-' x « e A/ pc)
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: 107/,27- �/ �/5l� �� �' IT
OWNER MAILING ADDRESS: ,P,1 ()/,5r /27, '`,/ j76"•
OWNER PROPERTY ADDRESS: S/4 C.--
TELEPHONE NUMBER OF CONTACT PERSON: 3 p`T2 3 - 9G z
TAX MAP NO. : Section /Q 0 Block 3 Lot J 3
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
S' nature of Applicant
RECEIVED BY: r •
Town Clerk's Of i e •
DATE: 7 ,
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