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JUDITH T. TERRY , Town Hall, 53095 Main Road
TOWN CLERK Z. p T P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
�✓ �� Fax (516) 765-1823
MARRIAGE OFFICER f o7.19.*
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�,yo� �1D/ �� Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1002 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 TWO 8'X 4' LEACHING POOLS TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. KEEP AT LEAST 10' APART. EXCAVATION
INSPECTION REQUIRED. CALL 765-1802 FOR AN APPOINTMENT.
Name Of Owner HAWKINS, SARA L.
Mailing Address 1 2065 MINNEHAHA BLVD.
City St Zip SOUTHOLD NY 11971
Property Address 1 2065 MINNEHAHA BLVD.
City St Zip SOUTHOLD NY 11971
Tax Map No. section 87.00 block 3_ lot 55.000
Cross Street NAKOMIS ROAD
Building Permit Number Cross Reference:
Issue Date: 5/24/93 Judith T. Terry
Southold Town Clerk
(TOWN ScAIi)
s' C®
JUDITH T. TERRY < Town Hall, 53095 Main Road
TOWN CLERK ® ' ac P.O. BOX 1179
REGISTRAR OF VITAL STATISTICS tri �� Southold, New York 11971
$ Fax (516) 765-1823
MARRIAGE OFFICER ® ®� v
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-Ato I 46N� �� Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK '• , a";
TOWN OF SOUTHOLD •
=t `, NM�AAY 2 1 1993 i 'Ii
TO: Southold Town Building Department • b
FROM: Linda Cooper, Southold Town Clerk's Office i`I ':-...r..-3. E c-1:1' -rt��f ,
DATED: May 21, 1993 $ 1"C�° '� ' ::O i! u+i.D:_.w_-.--._9
Transmitted herewith is a copy of application No. A1030 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Gary Tabor for Sara L. Hawkins
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 followin commendation:
APPROVE -
DISAPPROVE -
COMMENTS: 41, _604 IF
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EMAVA ON : 1SPECTICi 'gnature .i L
DatJe"! - ,- 1/` 3
OFFICE OF THE TOWN CLERKOOO
Town of Southold ••••'O�j ^ e'� \ Application No. TQ
Judith T. Terry, Town Clerk • :
0A
Town Hall, 53095 Main Road Z Construction
P. O. Box 1179 � �
' rn • Alteration
Southold, New York 11971 v' t,
Tele hone ;y0 Q ''� $10.00 - Residential /0
(516) 765-1801 =-��01. , ' $25.00 - Non-Residential
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE
APPLICANT NAME: (7)--1 ,-, y 2.9
APPLICANT ADDRESS: ZO 10 .S j
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
h/ S r ,00
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: _S ,,9J / /9", 14..) ) /1
OWNER MAILING ADDRESS: p, 6-- s
L" U7e
OWNER PROPERTY ADDRESS: S
TELEPHONE NUMBER OF CONTACT PERSON: 3 2 3- 2G o 7
TAX MAP NO. : Section 7 Block 3 Lot S S
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
VCY c41-1-�
ature of Applicant
RECEIVED BY: /1,4
Town Clerk's Offic •
DATE: -5—/a. / /9
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