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JUDITH T. TERRY � t� - Town Hall, 53095 Main Road
TOWN CLERK •
v T P.O. Box 1179
REGISTRAR OF VITAL STATISTICS UPS •W Southold, New York 11971
MARRIAGE OFFICER IO Fax Fax (516) 765-1823
�,y®1 .f •,' 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. 1028 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
INSTALLATION OF 8' X 8' LEACHING POOL TO AN EXISTING SYSTEM.
APPROVED WITH THE FOLLOWING STIPULATIONS: MAINTAIN REQURIED SCHD
DISTANCE FROM ADJACENT WELLS AND AN EXCAVATION INSPECTION IS REQUIRED.
Name Of Owner MUNSON, GORDON
Mailing Address 1 258 JEFFERSON AVENUE
City St Zip ST. JAMES NY 11780
Property Address 1 YOUNGS ROAD
City St Zip ORIENT NY 11957
Tax Map No. section 18.00 block 2 lot 7.000
Cross Street ROUTE 25
Building Permit Number Cross Reference:
Issue Date: 8/03/93 Judith T. Terry
Southold Town Clerk
(TOWN VAl.)
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JUDITH T. TERRY VT
r;' Town Hall, 53095 Main Road
TOWN CLERK cD ' t, P.O. BOX 1179
• c� Southold, New York 11971;�
REGISTRAR OF VITAL STATISTICS O A. I Fax (516) 765-1823
MARRIAGE OFFICER
�j�® �ri) 0 Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK 1-/ L1
TOWN OF SOUTHOLD J�� ;�'�� S93libil,
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TO: Southold Town Building Department sLO
6.�� G 76-ET "•tea°'
TO+J N OF SOU*OL
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: July 15, 1993
Transmitted herewith is a copy of application No. A1057 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
• Gary Tabor for Gordon Munson .
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:
114
APPROVE - C� EXCAVsf" � �p
DISAPPROVE -
COMMENTS: ' 4;•
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RECEIVED
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AUG ,'114,
Date
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OFFICE OF THE TOWNCLERK �%c31FU(4'(
Town of Southold _O Application No. /6 6-7
Judith T. Terry, Town Clerk ,
Town Hall, 53095 Main Road _ Construction•
P. O. Box 1179 Alteration
Southold, New York 11971 .y` O��u
Telephone mol t �� / Residential
(516) 765-1801 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: e'st / "ifa Ih O7
APPLICANT ADDRESS: 4 a /a,!/sry 3
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: 6- 0 l' 801-/ flUJi/S OW
OWNER MAILING ADDRESS: p.,5- /, °' i di 6 UC
Sl /41, ki'exes` frY, / 117 '�
OWNER PROPERTY ADDRESS: /a U,h,"\S'
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TELEPHONE NUMBER OF CONTACT PERSON: ' 2 J� - Co
TAX MAP NO. : Section l V Block Lot
CROSS STREET: /7p r-
BUILDING PERMIT NUMBER CROSS REFERENCE:
Gature of Applicant
ROMP
RECEIVED BY: ������ � '�
Town Clerk'dwt�fTice
DATE: ealt
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