HomeMy WebLinkAboutDorman, John a0 Gy;
JUDITH T. TERRY % Z Town Hall, 53095 Main Road
TOWN CLERK v T P.O. Box 1179
REGISTRAR OF VITAL STATISTICS s i1') ' Southold, New York 11971
MARRIAGE OFFICER Q �� Fax (516) 765-1823
74 • lit 1"- 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. 1104 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
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 AN 8' X 8' LEACHING POOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
BUILDINGS, WELLS AND PROPERTY LINES. EXCAVATION INSPECTION REQUIRED.
Name Of Owner DORMAN, JOHN
Mailing Address 1 BOX 165
City St Zip ORIENT NY 11957
Property Address 1 VILLAGE LANE
City St Zip ORIENT NY 11957
Tax Map No. section 25.00 block 1 lot 11 .000
Cross Street ROUTE 25
Building Permit Number Cross Reference:
Issue Date: 4/04/94 Judith T. Terry
Southold Town Clerk
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JUDITH T. TERRY Z .G L Town Hall, 53095 Main Road
TOWN CLERK G T ` P.O. Box 1179
REGISTRAR OF VITAL STATISTICS , IP �` • Southold, New York 11971
,� Fax (516) 765-1823
MARRIAGE OFFICER - O �' •
� � illt ��0 0� Telephone (516) 765-1801
,� � �I =
Wit
2 31111 U OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD EXCAYaMti INS MH
REQUIR
�j" �: "}"� .uthold Town Building Department
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FROM: Linda Cooper, Southold Town Clerk's Office
DATED: March 23, 1994
Transmitted herewith is a copy of application No. A1141 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Gary Tabor for John Dorman .
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.
z-
Linda J. Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the following recommendation:
APPROVE -
DISAPPROVE - EXCAVATION INSPECTION
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COMMENTS: • �/ :e.:ey (
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RECEIVED /
MAR 3 1 1994 °4 4
Signature
Town Berk Southold .0/Arr
Date
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OFFICE OF THE TOWN CLERK c�VFFU(,(� •
Town of Southold �� CO Application No. 119Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road gtr3Construction
P. O. Box 1179 Alteration
Southold, New York 11971 ���,!
Telephone �� Residential
P
(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 3/, 3 9
y
APPLICANT NAME: O'---,49i" y ic0Or
APPLICANT ADDRESS: b 1 .104 y 5 /•
J'iir- ni7 N1/4/ / /
SEPTIC CESSPOOL >/
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
5T,9'// kw7 cow
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: ' p lj 1l/ ))o t
OWNER MAILING ADDRESS: 00 /
Q f')/, 77.
OWNER PROPERTY ADDRESS: V/'/119!
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' '7y /. y /1 957
TELEPHONE NUMBER OF CONTACT PERSON: 3
TAX MAP NO. : Section Block ! Lot l l
CROSS STREET: 1C9 () 7.-t" 17/r
BUILDING PERMIT NUMBER CROSS REFERENCE:
l O
S' ature of Applicant
RECEIVED BY:
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7.. fowitClerk's Office
DATE:
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