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• JUDITH T.TERRY �/�� y1 Town Hall, 53095 Main Road
TOWN CLERK y i P.O. Box 1179
^y $ Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER ` � ��'�I�, Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER Ol `goo Fax
(516) 765-1800
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1484 R Residential X Non-Residential
Fee $ 10.00 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 A 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 FISCHER, DANIEL
Mailing Address 1 38785 ROUTE 25
City St Zip ORIENT NY 11957
Property Address 1 38785 ROUTE 25
City St Zip ORIENT NY 11957
Tax Map No. section 15.00 block 8 lot 1 .001
Cross Street RYDER FARM LANE
Building Permit Number Cross Reference:
Issue Date: 5/24/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY ������ y` Town Hall, 53095 Main Road
TOWN CLERK ; y = P.O. Box 1179
W P $ Southold, New York 11971
REGISTRAR OF VITAL STATISTICS 0 Fax (516) 765-1823
MARRIAGE OFFICER %-._-q°1
�f0 0��,/ Telephone(516) 765-1800
RECORDS MANAGEMENT OFFICER _ 1 4[ ��
FREEDOM OF INFORMATION OFFICER ,••0
OFFICE OF THE TOWN CLERK .
TOWN OF SOUTHOLD D 15 L J 11Fff
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: May 16, 1996
Transmitted herewith is a copy of application No. A1546 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Gary Tabor for Daniel Fischer ,
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.
A ,..,Z---
Signature
E)146:-
Date
OFFICE OF THE TOWN CLERK ,,,'"""
. Town of Southold ..'"400tir`+.
Judith T. Terr Town Clerk l/ Application No. /3^V
Town Hall, 535 Main Road ; = Construction
P. 0. Box 1179 ; o Alteration
Southold, New York 11971 tts
Telephone �yoj�,0 �����4 $10.00 - Residential c/
(5 6) 765-1801 : 1 '• $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 // S G
APPLICANT NAME: 6,-)) 1- y / j1CA
APPLICANT ADDRESS: Z9 rO pl/s Yy 5
SEPTIC CESSPOOL !/
DESCRIPTION OF PROPOSED CONSTRUCTION/OR ALTERATION j
1 5 %,,// �� Fl G� fs-1 e4 '�/ co /
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: £) )9k,/, 'C ` f/ Se
OWNER MAILING ADDRESS: 3 $ 7K5—' )70 ci 7- 2 s�
OWNER PROPERTY ADDRESS: 5
TELEPHONE NUMBER OF CONTACT PERSON: ( 7 3 Poo -7
TAX MAP NO. : Section 1,— Block Y Lot / i
CROSS STREET: / /d '7+.
BUILDING PERMIT NUMBER CROSS REFERENCE:
SWnature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
•
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