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JUDITH T: TERRY ; Town Hall, 53095 Main Road
TOWN CLERK • v T P.O. Box 1179
REGISTRAR OF VITAL STATISTICS trs �� Southold, New York 11971
MARRIAGE OFFICER 0 O. ,t, Fax (516) 765-1823
1D �� 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. 953 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 AN 8 X 8 LEACHING POOL TO AN EXISTING SYSTEM.
APPROVED WITH CONDITIONS. CHECK TO BE AT LEAST 100' FROM ALL
NEIGHBORS' WELLS. EXCAVATION INSPECTION REQUIRED. CALL FOR AN
APPOINTMENT (765-1802).
Name Of Owner HAASE, ROBERT
Mailing Address 1 8620 MAIN ROAD
City St Zip EAST MARION NY 11939
Property Address 1 8620 MAIN ROAD
City St Zip EAST MARION NY 11939
Tax Map No. section 31 .00 block 7 lot 5.000
Cross Street BAY AVENUE
Building Permit Number Cross Reference:
Issue Date: 1/15/93 Judith T. Terry
Southold Town Clerk
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JUDITH T. TERRY ` Town Hall, 53095 Main Road
TOWN CLERK ; ® 4,
P.O. BOX 1179
REGISTRAR OF VITAL STATISTICS 44 �> Southold, New York 11971
• w, r-N Fax (516) 765-1823
MARRIAGE OFFICER =®
l7.
�® Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK [177--N1
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TOWN OF SOUTHOLD 11!..);{} i 16`"
' JAN 1 21993 ' _i
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TO: - Southold Town Building Department _,
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FROM: Linda Cooper, Southold Town Clerk's Office 1 'ov^,p? op. :3:uiNpi.DA�
DATED: January 11, 1993
Transmitted herewith is a copy of application No. A980 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Gary Tabor for Robert Haase
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.
*it_r...Z.e.9
Linda J. Cooper
0
* • * * * * * * _ * * * * * *
I have reviewed the application and location map of the project listed
above and make the following recommendation:
APPROVE - p(
DISAPPROVE -
COMMENTS: v /AR. ca Y ) d'p cd.) /V ...4
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.eo Signature
Date
OFFICE OF THE TOWN CLERK c.OF
'Town of Southold 44-= Application No. Cf
Judith T. Terry, Town Clerk .0
Town Hall, 53095 Main Road • 8 Construction
P. O. Box 1179J� '
�- Alteration
Southold, New York 11971 ��-�•'
Residential
Telephone 0l ;
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 / / // / Sa
APPLICANT NAME: eft'
APPLICANT ADDRESS: 65-0 S
SEPTIC CESSPOOL - - - -- _
DESCRIPTION DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
�S
7.(9// K -e/4'e.1)//177 o o /
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: )7o 2 e ,y,As
OWNER MAILING ADDRESS: 5Jc/7't
OWNER PROPERTY ADDRESS: 7' 2-0 , 715;',/A-1/
/5/0-5j /' r, ' 0
TELEPHONE NUMBER OF CONTACT PERSON: (525 -
TAX
52`j -TAX MAP NO. : Section 3 / Block 7 Lot
CROSS STREET: /5/¢
BUILDING PERMIT NUMBER CROSS REFERENCE:
RECEIVED
C./
JAN 1 113 Signature of Applicant
RECEIVED BY:
own Clef' s Office
DATE:
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