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JUDITH T.TERRY �� Town Hall,53095 Main Road
TOWN CLERK kP.O.Box 1179
REGISTRAR OF VITAL STATISTICS I ��, Southold,New York 11971
MARRIAGE OFFICER ."4 O �`,*��, Fax(516)765-1823
RECORDS MANAGEMENT OFFICER --I* ED .osd Telephone(516)765-1800
FREEDOM OF INFORMATION OFFICER , SO
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1310 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 HILL, JACK
Mailing Address 1 525 ORCHARD STREET
City St Zip ORIENT NY 11957
Property Address 1 525 ORCHARD STREET
City St Zip ORIENT NY 11957
Tax Map No. section 25.00 block 2 lot 20.011
Cross Street NAVY STREET
Building Permit Number Cross Reference:
Issue Date: 4/07/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRY :' Town Hall, 53095 Main Road
TOWN CLERK ® P.O. Box 1179
tda %� Southold, New York 11971
REGISTRAR OF VITAL STATISTICS = a.® �� Fax (516) 765 1823
MARRIAGE OFFICER ==�'®1 �1� Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER = •f
FREEDOM OF INFORMATION OFFICER „Arlin°°
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLDF0
TO: Southold Town Building Department e G
FROM: Linda Cooper, Southold Town Clerk's Office € AR 0 1995
DATED: March 29, 1995 1',
BLDG.DEPT.
TOWN OF SOUTHOLD - `•
Transmitted herewith is a copy of application No. A1359 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Gary Tabor for Jack Hill
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.
72,Z.7.4.
- Signature
Date
I
OFFICE 'OF THE TOWN CLERK ,,,'"'"
Town of Southold .0 ,
. OVULire, = � S
Judith T. Terry, Town Clerk "4" G*4 Application No. ��
Town Hall, 53095 Main Road Construction
P. O. Box 1179 v II
Southold, New York 11971 cn - Alteration
Telephone ‘ , ° . 0-
$10.00 - Residential -�
=.01 �'a•"
(516) 765-1801 $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 3/9 y/ �
APPLICANT NAME: (j1 ) 4Or,
APPLICANT ADDRESS: / ,Er0 ,113/', 0 ,c' '
OPI'Cifril '7"
SEPTIC CESSPOOL
DESCRIPTION OF
J
OF PROPOSEDCONSTRUCTION OR�ALTERATION
t i ' 1477 ,0 0 i
'f0 EX/srJ,c)G- S VAST Em
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY:T -3---IC CESS ,i---j i' /it
OWNER MAILING ADDRESS: 6 9,c co/6c 44,,#AG/ S A
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OWNER PROPERTY ADDRESS: S ,,,1 .f-',
TELEPHONE NUMBER OF CONTACT PERSON: 3 2 ,7— p Z 6
TAX MAP NO. : Section Block '9 Lot (= () . 1/
CROSS STREET: /1AvI/
BUILDING PERMIT NUMBER CROSS REFERENCE:
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Sig3a'fure o,, f Applicant
RECEIVED BY: - U--461/2—%----1'
Town Clerk's Office
DATE: o� 7�� V
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