HomeMy WebLinkAboutSchultz (2) JUDITH T.TERRY � �� Town Hall,53095 Main Road
TOWN CLERK g P.O.Box 1179
REGISTRAR OF VITAL STATISTICS o Fax(516)765-1823
O '�� Southold,New York 11971
-1823
MARRIAGE OFFICER = � e�®��1� Telephone(516) 00
RECORDS MANAGEMENT OFFICER E3 ��
FREEDOM OF INFORMATION OFFICER �•�„ ,•is
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1270 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 AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION
INSPECTION REQUIRED.
Name Of Owner SCHULTZ, EDWARD
Mailing Address 1 BOX 84
City St Zip LAUREL NY 11947
Property Address 1 ALDRIDGE LANE
City St Zip LAUREL NY 11948
Tax Map No. section 127.00 block 1 lot 3.001
Cross Street ROUTE 25
Building Permit Number Cross Reference:
Issue Date: 1/19/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY ; ® �� % Town Hall,53095 Main Road
TOWN CLERK t co i4M. fk= 1 ,M p r1 �• :.: 11,197:7,
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REGISTRAR OF VITAL STATISTICS : ® ® � „tt '
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MARRIAGE OFFICER = �® �®���o 'p T l�phone(516)76511800
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IDAOF S®UTi 91.9
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: January 3, 1995
Transmitted herewith is a copy of application No. A1317 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Gary Tabor for Edward Schultz
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-7CAVATl t " INSPECTION
REQUIRED
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
D � , �t
Signature
JAN — 31995 L—A /77/,6/9:5—
Date
1 BLDG.DEPT.
TOWN OFSO
Y'
OFFICE OF THE TOWN CLERK c,VFFULk
y��1nw,of Southold ft
� �� Application No�'l
Judith T k berry, Town Clerk 3)7
Town Hall, 53095 Main Road M Construction
P. 0. Box 1179 vim. > .•1
0 V'
Southold, New York 11971 0�t Alteration
Telephone 01 .tyit `�•� ��� 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
/ / / 9' .s —
APPLICANT NAME: 6-A2 pi ` , AO�
APPLICANT ADDRESS: /? {�, O / n� py
- SEPTI CESSPOOL- I/ - - - - . -
DESCRIPTION OF PROPOSED CONSTRUCTION/ OR ALTERATION j
_7-- / S 7-*/ _// A -eicie /n7 ,c90
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: F c/w/v ,h q2 SC , 0 / T 2._..-
OWNER
OWNER MAILING ADDRESS: ,1--30/ 17
A .2v)--e /
OWNER PROPERTY ADDRESS: /9 , d A,' 4 9 e.. ,./¢ .._,
Aie vshe /
TELEPHONE NUMBER OF CONTACT PERSON: 3 O`1 3 - p, 6 ' 7
TAX MAP NO. : Section 1,71Z Block / Lot 3 /
CROSS STREET: KO 1 / e- s
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of Applicant
RECEIVED BY: / ; . �, r
-i-9-56rn erk's Office
DATE: �
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