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JUDITH T.TERRYt�_ t% 1 Town Hall, 53095 Main Road
TOWN CLERK i y Z t P.O. Box 1179
� I I Southold, New York 11971
REGISTRAR OF VITAL STATISTICS O
MARRIAGE OFFICER �41* NV- 1 Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER �.� `1►� �1O Fax
(516) 765-1800
FREEDOM OF INFORMATION OFFICER , s°1
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 74 N Residential Non-Residential X
Fee $ 25.00 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 CESSPOOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS
BUILDINGS, PROPERTY LINES, AND WATER BODIES. EXCAVATION INSPECTION
REQUIRED.
Name Of Owner ARM, HERBERT S.
Mailing Address 1 1675 JOCKEY CREEK DRIVE
City St Zip SOUTHOLD NY 11971
Property Address 1 1675 JOCKEY CREEK DRIVE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 70.00 block 2 lot 19.004
Cross Street OAKLAWN AVENUE
Building Permit Number Cross Reference:
Issue Date: 11/29/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY � � yt Town Hall, 53095 Main Road
TOWN CLERK Co = P.O. Box 1179
T �� Southold, New York 11971
REGISTRAR OF VITAL STATISTICS Oy ����, Fax(516) 765-1823
MARRIAGE OFFICER =1fO��� Telephone(516) 765-1800
RECORDS MANAGEMENT OFFICER 1 `�►
FREEDOM OF INFORMATION OFFICER • 00,0 •
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
19
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: November 18, 1996
Transmitted herewith is a copy of application No. 1642 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Gary Tabor for Herbert Arm
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.
Linda J. Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the following recommendation:
APPROVE -
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
RECEIVED
N OY2 51998
3 f�� Signa e Sol7
lhold Tame aft // , te, cl6-
Date
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OFFICE OF THE TOWN CLERK
Town of Southold .0.10fOIk�►- _
Judith T. Terry, Town Clerk ;' Ol/y . Application No. ie, `/ 2_
Town Hall, 53095 Main Road � �O = Construction
P. 0. Box 1179 z
Southold, New York 11971 fn. ; Alteration
Telephone �,� �' $10.00 - Residential
(5 6) 765-1801 ,'� $25.00 - Non-Residential
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE c7 ?6'
APPLICANT
APPLICANT NAME: ��V 7;47 h 62/Th
APPLICANT ADDRESS: 11!)' /:9- v/ 5 7
I-' ( !ti/
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: ?C�- QJ-j 5
OWNER MAILING ADDRESS: 1Z,, 73 � �J Ire 7 em
OWNER PROPERTY ADDRESS: 3
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section 70 Block 2- Lot l ?/.
CROSS STREET: rJ 41-if J :,4i'/
BUILDING PERMIT NUMBER CROSS REFERENCE:
cNature of Applicant
RECEIVED BY: AL) ALLA,,,t___c:
Town Clerk's Office
DATE: /V,/ `-er79 -
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