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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK < C=I
T • P.O. Box 1179
REGISTRAR OF VITAL STATISTICS � Southold, New York 11971
MARRIAGE OFFICER - 4® ®. ,4� Fax (516) 765-1823
'><',�®1 �1� 1� 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. 941 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 LEACHING POOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. HOLD 10' SEPARATION. EXCAVATION INSPECTION
REQUIRED. CALL FOR AN APPOINTMENT.
Name Of Owner OLSTAD, ANN
Mailing Address 1 JENNINGS ROAD
City St Zip SOUTHOLD NY 11971
Property Address 1 455 HORTONS LANE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 63.00 block 5 lot 20.000
Cross Street ROUTE 25
Building Permit Number Cross Reference:
Issue Date: 11/30/92 Judith T. Terry
Southold Town Clerk
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JUDITH T. TERRY 0 oo4 F, Town Hall, 53095 Main Road
TOWN CLERK '-vi Box 1179
REGISTRAR OF VITAL STATISTICS �� Southold, New York 11971
O �* Fax (516) 765-1823
MARRIAGE OFFICER ��/sy �'.�
�1 °� Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK =: �,' ' ( / �,,
TOWN OF SOUTHOLD z,5`'`4.,d �01/ // t �'� ?,,,,,,
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TO: Southold Town Building Department 41
FROM: Linda Cooper, Southold Town Clerk's Office ®r14 "r i
DATED: November. 24, 1992
i
Transmitted herewith is a copy of application No. A968 for an •
ALTERATION PERMIT for a cesspool or septic system submitted by
Gary Tabor for Ann Olstad .
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.
.
s.
• Thank you.
Linda J. Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the following recommendation:
APPROVE - X
DISAPPROVE -
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OFFICE OF THE TOWN CLERK ''''''''''
Town
Town of Southold gel'�
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'J v Application No. q
Judith T. Terry, Town Clerk �� � - ' Gy c
Town Hall, 53095 -Main Road . Construction _
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P. 0. Box 117 9 o - ter,
Southold, New York 11971 ct1 ;, . Alteration
Telephone =yO�. �� �� $10.00 -Residential
(516) 765-1801 l
'' $25.00- - Non-Residential
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT R E G E S V E
SEPTIC TANK or CESSPOOL`
NOV24 2
Permit No.
Southold Tomin'Cierk
Fee .$
3F- `
DATE -
APPLICANT NAME: "452_ .44 ‘97---
APPLICANT ADDRESS: %•ko /74
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SEPTIC-- -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: /4.67/4 ,%f �','7,52-
OWNER MAILING ADDRESS: T���,,'� oe",S >J- so O TI a 1Q/
OWNER PROPERTY _ADDRESS: .1716,1•7,/,, Ag A,,�+... -
TELEPHONE NUMBER OF CONTACT PERSON: S P3® 6 4-7
TAX MAP NO. : -Section3" Block ) Lot pP- ?
CROSS STREET: ?O % e__.
BUILDING PERMIT NUMBER CROSS ,REFERENCE: •
Sig iature of Applicant
RECEIVED BY: -
To C rk's affice
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