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HomeMy WebLinkAboutGustavson, Troy Y FOIK�OGy JUDITH T. TERRY = Z Town Hall, 53095 Main Road TOWN CLERK Ca T P.O. BOX 1 179 Southold, New York 11971 cti REGISTRAR OF VITAL STATISTICS y Fax (516) 765-1823 MARRIAGE OFFICER O O� 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. 1106 R Residential X Non-Residential Fee $ 10.00 Septic X Cesspool PERMIT ISSUED TO: Name : MORRIS CESSPOOL SERVICE Address 1 : 2760 YENNECOTT DRIVE City St Zip SOUTHOLD NY 11971 Descripton of Proposed Construction or Alteration ADDITION OF AN OVERFLOW TO AN EXISTING SYSTEM. APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS, BUILDINGS, AND PROPERTY LINES. EXCAVATION INSPECTION REQUIRED. Name Of Owner GUSTAVSON, TROY ------------------ ----------- Mailing Address 1 595 KING STREET ------------------------------ ------------------------------ City St Zip ORIENT NY 11957 -------------------- -- ---------- Property Address 1 595 KING STREET ------------------------------ ------------------------------ City St Zip ORIENT NY 11957 -------------------- -- ---------- Tax Map No. section 26.00 block 1 lot 30.000 ------ --- ------ Cross Street NAVY STREET ------------------------------ Building Permit Number Cross Reference: ---------------------------------- Issue Date: 4/04/94 Judith T. Terry -------- Southold Town Clerk _1 TOWN SF-AL-1 o��FFOIk�OGy JUDITH T. TERRY Town Hall, 53095 Main Road ZP.O. Box 1179 TOWN CLERK Southold, New York 11971 REGISTRAR OF VITAL STATISTICS �. Fax (516) 765-1823 MARRIAGE OFFICER ' ��0 Telephone (516) 765-1801 RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK D WE TOWN OF SOUTHOLD MAR 2 5 ft TO: Southold Town Building Department TOWN pl�j�lD FROM: Linda J. Cooper, Southold Town Clerk's Office DATED: March 24, 1994 Transmitted herewith is a copy of application No. 1143 for a Cesspool/ Septic Tank Construction Permit submitted by: Morris Cesspool Service for Troy Gustayson 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. Thank you. Linda J. Cooper * * * * * * * * * * * * I have reviewed the application and location map of the project cited above and make the following recommendations: APPROVE �/ EXCAVATION INSPECTION DISAPPROVE REQUIRED Comments: i RELIVED MAR j 1994 Signatupd Town Clerk SOMA ��/ 9 Dated � 4 OFFICE OF THE TOWN CLERK Town of Southold �j�FF��K�'� Application No.�� Judith T. Terry, Town Clerk Town Hall, 53095 Main Road Construction P. 0. Box 1179 Southold, New York 11971 Alteration Telephone O,y �Q� $10.00 - Residential c/ (516) 765-1801 l $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: APPLICANT ADDRESS: _ Z_ /10 2 SEPTIC CESSPOOL /,--- DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION LOCATION MAP: Must be attached hereto before permit may be issued. LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: OWNER OF PROPERTY: OWNER MAILING ADDRESS: &7,1.e,,,Z_ c2,K OWNER PROPERTY ADDRESS: TELEPHONE NUMBER OF CONTACT PERSON: TAX MAP NO. : Section 1L'11" Block Lot CROSS STREET: zz BUILDING PERMIT NUMBER CROSS REFERENCE: Signature of Applicant RECEIVED BY: Town Clerk's Office DAT E: REQ MAR 2 41994 Town Clerk Southold `t� 5 rc