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11 JUDITH T. TERRY , Town Hall, 53095 Main Road
TOWN CLERK ® ; �, P.O. Box 1179
&81REGISTRAR OF VITAL STATISTICS k � Southold, New York 11971
�� Fax (516) 765-1823
MARRIAGE OFFICER -= ` v., 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. 1285 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 A 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 ROBERTSON, ALLAN
Mailing Address 1 181-15 HEWLEY ROAD
City St Zip JAMAICA NY 11432
Property Address 1 355 WEST LANE
City St Zip EAST MARION NY 11939
Tax Map No. section 38.00 block 6 lot 2.000
Cross Street OLD ORCHARD LANE
Building Permit Number Cross Reference:
Issue Date: 2/06/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY ` n
,_ ''= Town Hall, 53095 Main Road
TOWN CLERK , i f % P.O.Box 1179
REGISTRAR OF VITAL STATISTICS y 0 Southold,New York 11971
O ;.,71,4-...1
. .1 Fax(516)765-1823
MARRIAGE OFFICER ,
RECORDS MANAGEMENT OFFICER ''........7/4 `�j 0. Telephone(516)765-1800
FREEDOM OF INFORMATION OFFICER �„ ,,•��
OFFICE OF THE TOWN CLERK ,
TOWN OF SOUTHOLD 'xo 0
TO: Southold Town Building Department -"3.% , d
FROM: Linda Cooper, Southold Town Clerk's Office pOo :,
DATED: January 31, 1995 G�yo ,.',, ��
Transmitted herewith is a copy of application No. A1332 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Gary Tabor for Allan Robertson
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 - z...-----
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
IP .77 ,ge
Signatur' /
Date
•.,
OFFICE OF THE TOWN CLERK c0FOG�'`+-
Town of Southold &,N)
Judith T. Terry, Town Clerk -
{<, y . Application No./
Town Hall, 53095 Main Road 8 ' _ Construction
P. O. Box 1179
Southold, 'New York 11971oyo �O I Alteration
Telephone
_ sye l • Residential
(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 /5/ 9�
APPLICANT NAME: f i4e40,6
APPLICANT ADDRESS: h„,/#l/‘/ $
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
1 5 %fr".7/ 57. 8 I-est I k7 C9 c>
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: / 1 ��-/ _17�,be} TS Oh/
OWNER MAILING ADDRESS: ) /—}5 ,LJ. 1//e-/
if 0462 ' 14 / / �-
OWNER PROPERTY ADDRESS: 356-- 7�c/ e �5 j /gei/e_
TELEPHONE NUMBER OF CONTACT PERSON: (7 ,P3- 6 7
TAX MAP NO. : Section 3 r Block Lot a.
CROSS STREET: C01.,el_et, p•fe
BUILDING PERMIT NUMBER CROSS REFERENCE:
nature of Applicant
RECEIVED BY: (/l
L1
Town Clerk's Office
DATE: (/ //9�
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