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JUDITH T. TERRY Town Hall, 53095 Main Road
P.O. Box 1179
TOWN CLERK ® 1r t,
REGISTRAR OF VITAL STATISTICS .�` Southold, New York 11971
MARRIAGE OFFICERV o ''�. Fax (516) 765-1823
"1/4, 01
01 , ,�!' 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. 830 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 4 X 8 LEACHING POOL
APPROVED AS SUBMITTED. EXCAVATION INSPECTION REQUIRED.
Name Of Owner SEIDMAN, NATHAN B.
Mailing Address 1 343 9TH STREET
City St Zip NEW YORK NY 10003
Property Address 1 29215 MAIN ROAD
City St Zip ORIENT NY 11957
Tax Map No. section 13.00 block 2 lot 9.000
Cross Street HEATH DRIVE
Building Permit Number Cross Reference:
Issue Date: 5/07/92 Judith T. Terry
Southold Town Clerk
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,1!l IST- U
JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS os .� Southold, New York 11971
MARRIAGE OFFICER V769.
Fax (516) 765-1823
VAIO %®,6! Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
May 1 , 1992
To: Southold Town Code Enforcement 'Officer
From: Linda J. Cooper, Southold Town Clerk's Office
Transmitted herewith is a copy of application No. A854 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Gary Tabor for Matthew Seidman
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 - �C
DISAPPROVE -
COMMENTS: (,, ,A,,,,eXrt. �, a trcA c Q Z,lc ttt • .9
RECt
,VED
MAYO 71c-
(�� Town Clerk Souttrold
DE2.44.4.12_
Signature
r.. ., Date
OFFICE OF THE TOWN CLERK ,,,''",,,,
Town of Southold .`' �FFOiKe
�'J Application No. g5
Judith T. Terry, Town Clerk `� G�;
='
Town Hall, 53095 Main Road - -- � ; re..1 Construction
P. O. Box 1179 t: rn ; Alteration
Southold, New York 11971 %LP �.`
Telephone y .�
P - VI $10.00 - Residential
(516) 765-1801 = "1 * $• ' $25.00 - Non-Residential
..../i'
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION.
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. •
•
Fee $ i
DATE g_ sT /P/
APPLICANT NAME: •,/,i' 7/ J
APPLICANT ADDRESS: o '-‘2 ,17/,401 /57.-'
) ,�C ' j - //9s;2
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
add -1(r e „e,1 /
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: /77jam //
OWNER MAILING ADDRESS:
OWNER PROPERTY ADDRESS: /81 A , h/ re,
57
TELEPHONE NUMBER OF CONTACT PERSON: 3 -- v`? GG
TAX MAP NO. : Section J` Block Lot 7
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
i gnature of Applicant
• RECEIVED BY:
Town Clerk's Office •
DATE:
N1
•
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