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JUDITH T. TERRY ` Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
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Southold, New York 11971
REGISTRAR OF VITAL STATISTICS = \\ Fax (516) 765-1823
MARRIAGE OFFICER Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER '_
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. 1252 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
INSTALL 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 LOLIC, MIKE
Mailing Address 1 99 VINCENT ROAD
City St Zip HICKSVILLE NY 11801
Property Address 1 140 PINE AVENUE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 77.00 block 3 lot 3.001
Cross Street HICKORY ROAD
Building Permit Number Cross Reference:
Issue Date: 11/28/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRY �,,_ .G ; Town Hall, 53095 Main Road
TOWN CLERK : =v T P.O. Box 1179
U' � Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
‘10,0,4‘,. �. ��� Fax (516) 765-1823
MARRIAGE OFFICER _ 1 41, To ,• Telephone (516) 765-1801
RECOFREEDOM OS F MANAGEMENT
ON OFFICER 'WI
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OFFICE OF THE TOWN CLERK - , iii f;
TOWN OF SOUTHOLD
TO: Southold Town Building Department ivr-ir ? 3 +994
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: November 23, 199L1 f.' ,�'. OEP7 "-..'
OF 50, T
Transmitted herewith is a copy of application No. A1298 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Gary Tabor for Mike Lolic
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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 - L./-*--
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells, buildings,
property lines and water bodies. EXCAVATION INSPECTION
REQUIRED. MEM
REQUIRED
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Signatu /
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OFFICE OF THE TOWN CLERK S�FFULk'
Town of STown Clerkuthold
Application No./ l2 8
Judith T. Terryy,,
Town Hall, 53095 Main Roadgal Construction
P. O. Box 1179 'W$ Alteration C�
Southold, New York 11971 O ��- .�
Tele hone *0 t Ne �� Residential
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(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 $ q
DATE f
APPLICANT NAME: /(92-' y J /42 '146/ 7\
APPLICANT ADDRESS: Zs, $ Oi2l// S /
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SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION Og. ALTERATION
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LOCATION MAP: Must be attached her to before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION ORA TERAT ON:
OWNER OF PROPERTY: /J/1i1flc� // c
OWNER MAILING ADDRESS: / /� `✓�Z� Av% Jrc
/2711 'e Sy,' /?/ y' l ) mal
OWNER PROPERTY ADDRESS: /y/O 717/ ,g ? ‘7.1--;:fi'.,,C1-
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TELEPHONE NUMBER OF CONTACT PERSON: 3 g.T -
TAX MAP NO. : Section 7 7 Block 3 Lot / 3 - 1
CROSS STREET: //, ' C/1 0 71 /
BUILDING PERMIT NUMBER CROSS REFERENCE:
Sigire of Applicant
RECEIVED BY: z6/j
Town Clerk's O ice
DATE: //6 /9I
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