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Home My WebLink AboutGillispieFFICE OF THE TOWN CLERK Town of Southold udith T. Terry, Town Clerk Fown Hall, 53095 Main Road P. O. Box 1179 Southold, New York 11971 Telephone (516) 765-1801 TOWN OF SOUTHOLD Application No. Construction Alteration $10.00 -Residential J $25.00 -Non-Residential 5OUTNOLD WASTEWATER DISPOSAL DISTRICT APPLICAT,ON 01$J PPI 0¥AL fo r CONSTRUCTION or ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. Fee $ DATE APPLICANT NAME: 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: r,~,., \\t~,~ ~'~_~-,'~,3 ~,~e T~,.3"~' . ~'~,-c-_~ .-~'o~'~-- OWNER MAILING ADDRESS: OWNER PROPERTY ADDRESS:y~:'~ TAX MAP NO.: Section ~ Block~ CROSS STREET: ~ ~ BUILDING PERMIT NUMBER CROSS REFERENCE: ECEIVED BY: ATE: To~wn~~fice Si~a t u~-~ o f Applicant ELIZABETH A. NEVILLE TOWN CLERK ~ REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MA~\'AGEMENT OFFICER FREEDOM OF Ib,'FORMATION OFFICER Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit NO. 3030 R Fee $ 10.00 PERMIT ISSUED TO: Name : GARY TABOR Address 1: PO BOX 659 City St zip ORIENT Residential x Non-Residential Septic X Cesspool NY 11957 Descriptor of Proposed construction or Alteration ADDITION TO EXISTING SYSTEM. APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION INSPECTION REQUIRED. Name Of Owner GILLISPIE/TRMINABLE INT Mailing Address 1 14895 MAI ROAD city St zip Property Address 1 EAST MARION NY 11939 14895 MAIN ROAD city st zip Tax Map NO. section Cross Street Building Permit Number cross Reference: zssue Pate: 5/14/03 EAST MARION NY 11939 23.00 block i lot 2.007 BAY AVENUE Southold Town Clerk (TOWN SEAL) OFFICE OF THE TOWN CLERK Town of Southold Judith To Terry, Town Clerk Town Hall, 53095 Main Road P. O. Box 1179 Southold, New York 11971 Telephone (516) 765-1801 TOWN OF SOUTHOLD Application No.,~ Construction Alteration $10.00-Residential j $25.00 - Non-Residential SOUTHOLD WASTEWATER DISPOSAL DISTRICT I PPROVAL APPLICATION for CONSTRUCTION or ALTERATION PERMIT SEPTIC TANK or CESSPOOL RECEIVED APR 2 5 2003 SouthoH Town Clerk Permit No. Fee $ APPLICANT NAME: APPLICANT ADDRESS: · 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: 7'/',~ ~/~e z~ ~, ~,/7 P/'O~ OWNER MAILING ADDRESS: OWNER PROPERTY ADDRESS: /,f/ ,~C~..5~ J J j' ~ l ;~ ~ J TELEPHONE NUMBER OF CONTACT PERSON:_ ~,~-~&&~ TAX MAP NO.: Section ~ ~ Block ~ Lot CROSS STREET: ~. ~.~~ BUILDING PERMIT NUMBER CROSS REFERENCE: RECEIVED BY: DATE: Town Clerk's Office ~'gnatU re'of Applicant