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
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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
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Mailing Address 1 595 KING STREET
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City St Zip ORIENT NY 11957
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Property Address 1 595 KING STREET
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City St Zip ORIENT NY 11957
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Tax Map No. section 26.00 block 1 lot 30.000
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Cross Street NAVY STREET
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Building Permit Number Cross Reference:
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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
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