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JUDITH T.TERRYt� c .fit Town Hall, 53095 Main Road
TOWN CLERK 4 4 P.O.Box 1179
.+0 ,1 Southold,New York 11971
REGISTRAR OF VITAL STATISTICS 1 Fax(516)765-1823
MARRIAGE OFFICER � /� %trio.
RECORDS MANAGEMENT OFFICER : VI jig `t►gill Telephone(516)765-1800
FREEDOM OF INFORMATION OFFICERi•��
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 55 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 AN 8 X 8 LEACHING POOL 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 SCHULTZ, EDWARD
Mailing Address 1 DAVID'S DOG GROOMING
BOX 84
City St Zip LAUREL NY 11948
Property Address 1 ALDRICH LANE
City St Zip LAUREL NY 11948
Tax Map No. section 127.00 block 1 lot 3.001
Cross Street ROUTE 25
Building Permit Number Cross Reference:
Issue Date: 12/28/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY Town Hall,53095 Main Road
TOWN CLERK ea Z ; P.O.Box 1179
REGISTRAR OF VITAL STATISTICS `0 V$ Southold,New York 11971
MARRIAGE OFFICER Fax(516)765-1823
RECORDS MANAGEMENT OFFICER --y_6l 4i, *-„.0 Telephone(516)765-1800
FREEDOM OF INFORMATION OFFICER ---,,,,to
OFFICE OF THE TOWN CLERKTOWN OF SOUTHOLD IUMN
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TO: Southold Town Building Department I
FROM:
Linda Cooper, Southold Town Clerk's Office DEC 2 7
t
DATED: December 23, 1994 BLDG.DEPT
TOWN OF SOUTHOID
Transmitted herewith is a copy of application No. A1315 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Gary Tabor for Edward Schultz (David's Dog Grooming) .
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 -
01111111011 INSPECTION
DISAPPROVE INUNIED
-
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
as- //tSe°1104_
Signature
7V/V'tX,/
Date
SOF TCE OF THE TOWN CLERK fFOLj' /ike9
Town of Southold Application No. 73/5--
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road Construction
P. O. Box 1179 10 "s..... 4tr,
Alteration
Southold, New York 11971 �-
Telephone 1_ 44 $ Residential
(516) 765-1801 Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $ 015-
DATE /p/2,1--/?Y
APPLICANT NAME: �r / )
APPLICANT ADDRESS: `I�/7 !//
1f ' eir/ Z'
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
/47// �� � 1 -e,41(c. ��� 0 o /
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: GZ/Gt� �¢ /►d Sect / T Z
OWNER MAILING ADDRESS:Z:9
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OWNER PROPERTY ADDRESS: �� ' qe A,a�/��
A-t) tie,/
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section / 2- 7 Block f Lot 3 —
CROSS STREET: KO v j
BUILDING PERMIT NUMBER CROSS REFERENCE:
naiihre of Applicant
RECEIVED BY: RECEIVED
Town Clerk's Office
DATE: DEC 2 1994
Southold Town Clerk
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