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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK t ® rrt P.O. Box 1179
REGISTRAR OF VITAL STATISTICS U' � Southold, New York 11971
�� Fax (516) 765-1823
MARRIAGE OFFICER -",'44‘40 ®� •
4j �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. 1010 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 SEPTIC TANK AND TWO LEACHING POOLS.
APPROVED AS SUBMITTED. KEEP 10' APART. EXCAVATION INSPECTION
REQUIRED.
Name Of Owner SBLENDIDO, DOMINICK
Mailing Address 1 6 CLARK STREET
City St Zip HUNTINGTON NY 11743
Property Address 1 185 INLET LANE
City St Zip GREENPORT NY 11944
Tax Map No. section 43.00 block 4 lot 37.000
Cross Street MANHASSET AVENUE
Building Permit Number Cross Reference:
Issue Date: 6/08/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL )
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CLERK' Y TOWN OF S®@J'�FI®LL? • T Tow; Ha 53095 Main Road
P. . Box 1179
TOWN OF SOl�1- O�uthol , New York 11971
REGISTRAR OF VITAL STATISTICS ” y P_ 51 765-1823
MARRIAGE OFFICER O ®o' •
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Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: June 7, 1993
Transmitted herewith is a copy of application No. A1039 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Gary Tabor for Dominick Sblendido
•
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.
a rc-6c9
. Linda J. Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the following recommendation:
APPROVE -
DISAPPROVE -
COMMENTS: .....4 /® I _z,/
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REOUIRED
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OFFICE- OF THE TOWN CLERK OV FOL/r.
To�rrn of SoutholdApplication No. �
Judith T. Terry, Town Clerk a?
7
Town Hall, 53095 Main Road • 8 _'
to c r Construction
P. O. Box 1179 � J Alteration
Southold, New York 11971 0�-s!
Telephone �1 i 'j Residential
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
APPLICANT NAME:
APPLICANT ADDRESS: p8-D )/,g f/r S
SEPTIC V-CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
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• LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: /) d/vi / /�/7 S ,6 Je mc/, !do
OWNER MAILING ADDRESS: -i!a e/ ,/'v1- S 7
1/u1-/T, ' 7/7 j ✓ 1171713
OWNER PROPERTY ADDRESS: J 3 ,-✓/e % A"ta,e--,/"e--
TELEPHONE NUMBER OF CONTACT PERSON: � —� �y 1p 7
TAX MAP NO. : Section 11 3 Block - 1/ Lot (7 7
CROSS STREET: i•V, / ,s'S. %
BUILDING PERMIT NUMBER CROSS REFERENCE:
Si ture of Applicant
RECEIVED BY: .
TowClerk s Office
DATE: (7 /fl3
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