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ELIZABETH A. NEVILLE $, Gy�; Town Hall, 53095 Main Road
TOWN CLERK p '� P.O. Box 1179
ti Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS Al
MARRIAGE OFFICER
O Fax (516) 765-6145
RECORDS MANAGEMENT OFFICERy51fO 4O�''�� Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER - '� ilk ,0
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2123 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 CESSPOOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM WELLS,
BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION INSPECTION
REQUIRED.
Name Of Owner POLLOCK, ARTHUR
Mailing Address 1 318 THIRD STREET
City St Zip GREENPORT NY 11944
Property Address 1 535 MAIN STREET
City St Zip GREENPORT NY 11944
Tax Map No. section 34.00 block 1 lot 15.000
Cross Street WILMARTH AVENUE
Building Permit Number Cross Reference:
Issue Date: 7/28/99 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE �1 h`1`� ��, `�` ;;'Town Hall, 53095 Main Road
TOWN CLERK ; c . ., W 2 P.O. Box 1179
REGISTRAR OF VITAL STATISTICS � cA Southold, New York 11971
MARRIAGE OFFICER
O c � 1 Fax (516) 765-6145
RECORDS MANAGEMENT OFFICER �`y* .fii F Q {• Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER �'� a-'
''''••~„ ,so
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: July 20, 1999
Transmitted herewith is a copy of application No. 2211 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Gary Tabor for Arthur M. Pollock .
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.
Signature
1 / 1- 1 /'i'i
Date
.CE OF THE TOWN CLERK -"'--
Town of Southold ,,'�st��FFetkl' Application No.
4th Te( Terry, Town Clerk ,
Towcw Hal, 53095 Main Road < Construction
P. O. Box 1179
Alteration
Southold, New York 11971
Telephone =y0 11 $10.00 -Residential
(516) 765-1801 :"" $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 7/4? /7
APPLICANT NAME: 11 11X f 14 O t
APPLICANT ADDRESS: 1Q 3 f..
ti C
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: 1,7�tj y ,yi- /}�oJ/a
OWNER MAILING ADDRESS:_TTT�—=,�^,''^-�v�': S t_„ 3 IA 3d St
OWNER PROPERTY ADDRESS: 5 53 5 MA.„(-1
re E ) O►r'�
TELEPHONE NUMBER OF CONTACT PERSON: 33-- 6, e.07
TAX MAP NO. : Section 3Y. Block J Lot L5�
CROSS STREET: 7<ji YftALt 7' , 0-- '
BUILDING PERMIT NUMBER CROSS REFERENCE:
S' ature of Applicant
RECEIVED BY: Al
Town C erk s ffice
DATE: -7/40 tJ/Qe
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410/1/ 31
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