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JUDITH T. TERRY • Z .0 ; Town Hall, 53095 Main Road
•
TOWN CLERK =o /_ P.O. Box 1179
cls .� • Southold, New York 11971
REGISTRAR OF VITAL STATISTICS = VO � Fax (516) 765-1823
MARRIAGE OFFICER = /fr, ,�O ��� Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER 1
FREEDOM OF INFORMATION OFFICER „,,I'I
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1237 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : GARY TABOR
Address 1 : NAVY STREET
City St Zip ORIENT NY 11957
Descripton of Proposed Construction or Alteration
INSTALLATION OF AN 8 X 8' 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 LAWTHER, AUSTIN
Mailing Address 1 5705 INDIAN NECK LANE
City St Zip PECONIC NY 11958
Property Address 1 5705 INDIAN NECK LANE
City St Zip PECONIC NY 11958
Tax Map No. section 86.00 block 6 lot 15.000
Cross Street ROUTE 25
Building Permit Number Cross Reference:
Issue Date: 11/15/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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. :
JUDITH T. TERRY ,, ` ; Town Hall, 53095 Main Road
TOWN CLERK : v T : P.O. Box 1179
VI W , Southold, New York 11971
REGISTRAR OF VITAL STATISTICS = VO ��� Fax (516) 765-1823
MARRIAGE OFFICER '_/� .4o r/ Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER — I 41 .l
FREEDOM OF INFORMATION OFFICER � �,,,,,,//°��
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department `
FROM: Linda Cooper, Southold Town Clerk's Office INSPECT"
DATED: October 26, 1994YA
REQUIRED
Transmitted herewith is a copy of application No. A1283 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Gary Tabor for Austin Lawther
•
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.
�- Ogig61994
Linda J. Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the following recommendation:
APPROVE - 4
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells, buildings,
property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
i LiZ
Signature
// /v*
Date
f�F E OF THE TOWN CLERK „C.OFQ�/�'`+'
JudithTown of SoutholdT. Terry, Town Clerk Application No. e 3
Town Hall, 53095 Main Road Construction
P. 0. Box 1179 *.$ Alteration
Southold, New York 11971 ��-
Telephone '2/ ' �� Residential
Tele
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 /0
APPLICANT NAME: / Or
APPLICANT ADDRESS: /7v 5 7
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
a im-// Y 'rOn �.
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: /905 7. 'i✓' /4/91,./
OWNER MAILING ADDRESS: ,5"---70.5-
o
.37G.5-
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: //` '2 3- 4 - 6• 4 77
TAX MAP NO. : Section 4/ Block Co Lot �S '
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
c_,47cail-e-'----
Siighature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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