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JUDITH T.TERRY ' �� •
Town Hall,53095 Main Road
TOWN CLERK P.O.Box 1179
REGISTRAR OF VITAL STATISTICS V 0 Southold,New York 11971
MARRIAGE OFFICER A Fax(516)765-1823
RECORDS MANAGEMENT OFFICER : ®� ED Iv 00 Fax
(516)765-1800
FREEDOM OF INFORMATION OFFICER . „„ SI"
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1348 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 SHAPIRO, BARRY
Mailing Address 1 625 INDIAN NECK LANE
City St Zip PECONIC NY 11958
Property Address 1 625 INDIAN NECK LANE
City St Zip PECONIC NY 11958
Tax Map No. section 86.00 block 6 lot 7.000
Cross Street MAIN ROAD
Building Permit Number Cross Reference:
Issue Date: 6/26/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRY . I �+C.� _, Town Hall, 53095 Main Road
TOWN CLERK ® vim 14„ 4 iv P.O. Box 1179
�' 3 ;P �� Southold, New York 11971
REGISTRAR OF VITAL STATISTICS c� 4 ��' Fax (516) 765-1823
MARRIAGE OFFICER ®�" �1�
RECORDS MANAGEMENT OFFICER =- � 0� Telephone (516) 765 1801
FREEDOM OF INFORMATION OFFICER _ ®�.e. A /di��'.
OFFICE OF THE TOWN CLERK .11; - H `�! I -
TOWN OF SOUTHOLD 1 t �:w�a,-..... :2_-_-______I________11,--u ;,
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TO: Southold Town Building Department i;_;,ti' JUN 191995 _r
I'
FROM: Linda Cooper, Southold Town Clerk's Office i __ i j;
DATED: .D c4 DEFi
June 16, 1995 „ TOWN ' CIS' 'D
Transmitted herewith is a copy of application No. A1399 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Gary Tabor for Barry Shapiro
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 -
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
c ; ".7771--,iy,, e-1-
Signature
"/-2-2/95"--
Date
C i-I ICt OF THE TOWN CLERK ,,,,,
Town of Southold 41' I"UI�
Judith T. Terry, Town Clerk 1�' ®� s-..' Application No. ,/�
Town Hall, 53095 Main Road Z Construction r/
P. O. Box 1179 c rn
Southold, New York 11971ct� Alteration
Telephone = �tve�0 �O , � $10.00 - Residential
(516) 765-1801 1 4 ,
, "• $25.00 -Non-Residential
,..r,,'
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
Ji
DATE ( 9 3
APPLICANT NAME: - 40 7`'
APPLICANT ADDRESS: /a •fid �ij/A 1// \/
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: A 1 / y
OWNER MAILING ADDRESS: (6 a✓ /7 e
OWNER PROPERTY ADDRESS: 5,
TELEPHONE NUMBER OF CONTACT PERSON: 37
TAX MAP NO. : Section g 6 Block 6 Lot 7
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
S' nature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE: 6 /co • gs-
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