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JUDITH T. TERRY c===.J
Town Hall, 53095 Main Road
TOWN CLERK f P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER GO fir' Fax (516) 765-1823
��� ,sS22� �� ��!' 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. 829 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 A 4 X 8 LEACHING POOL.
APPROVED AS SUBMITTED. EXCAVATION INSPECTION REQUIRED.
Name Of Owner MELLINGER, CLYDE
Mailing Address 1 1495 VILLAGE LANE
City St Zip ORIENT NY 11957
Property Address 1 1495 VILLAGE LANE
City St Zip ORIENT NY 11957
Tax Map No. section 25.00 block 3 lot 2.001
Cross Street ORCHARD STREET
Building Permit Number Cross Reference:
Issue Date: 5/07/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRY
Town Hall, 53095 Main Road
TOWN CLERK 'r® ; ti'
P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ' '.�` Southold, New York 11971
MARRIAGE OFFICER k. j O i�� Fax (516) 765-1823
��®� ijitti �b®��! Telephone (516) 765-1801
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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. A853 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Gary Tabor for Clyde Mellinger
•
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 - pC
DISAPPROVE r„ - n 1 (�
COMMENTS: acn� �l t ec rX o►
ca .c sJ ,,,ok.t.¢L c',1G1 . c& 244_
N.a eR.o4s.. •-0 RECEIVED
• MAY 0 71o,'
�i� Town Clerk Southold
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�#4,4, Signature
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Date t t
OFFICE OF THE TOWN CLERK ,'''' '''' _
Town of Southold .'' �FFEILK 3
5 "`" G�� ' Application No. es
-N3
T. Terry, Town Clerk �� ry
' Town Hall, 53095 Main Road ; Construction
P. 0. Box 1179 ; = S, m
Southold,. New York 11971 tt1 Alteration
Telephone y�,f' �•
�r•�' $10.00 - Residential ✓
(516) 765-1801 01 t , ' $25.00 - Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. -
Fee .$
DATE '// 23 7 /
APPLICANT NAME: O,h-
APPLICANT ADDRESS: ��/ -y S
0)-11 ' r
SEPTIC CESSPOOL 1/
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: e /,„/ ., f/,� C. •
OWNER MAILING ADDRESS: /9 9' fr•i //,/,././re.. •
OWNER PROPERTY ADDRESS: ' 5�
TELEPHONE NUMBER OF CONTACT PERSON: 323- .2 Cob 7
TAX MAP NO. : Section /Od c7 Block 2.5 Lot 3, 2
CROSS STREET: ,,?-7(pji ,*�Ji,e," 3 j
BUILDING PERMIT NUMBER CROSS REFERENCE:
signature of Applicant
RECEIVED BY: (4 •
Town Jerk's Office •
DATE: 5--/—
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