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JUDITH T. TERRY Hall, 53095 Main Road
� P.O. Box 1179
TOWN CLERK p not �,
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REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER r� ® �
t . �� Fax (516) 765-1823
® .�! Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 914 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
INSTALL 8 X 8 OVERFLOW POOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. HOLD THE NEW POOL 10'0" FROM EXISTING AND CALL
FOR EXCAVATION INSPECTION.
Name Of Owner SIMPSON, THEODORE
Mailing Address 1 BOX 239
City St Zip SOUTHOLD NY 11971
Property Address 1 125 BRIGANTINE DRIVE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 71 .00 block 2 lot 18.000
Cross Street HARBOR LIGHTS DRIVE
Building Permit Number Cross Reference:
Issue Date: 10/14/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRYTown Hall, 53095 Main Road
TOWN CLERK p f P.O. Box 1179
REGISTRAR OF VITAL STATISTICS .�` Southold, New York 11971
``�' SAG FFIC O A, Fax (516) 765-1823
ri I1 p-T:w,S i ® ®'•!� Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
t' 7iii 1l` ___ TOWN OF SOUTHOLD
September 28, 1992
To: Southold Town Code Enforcement 'Officer
From: Linda J. Cooper, Southold Town Clerk's Office
Transmitted herewith is a copy of application No. A 938 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Gary Tabor for Theodore Simpson
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 - K
DISAPPROVE -
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OF Date
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OFFICE OF THE TOWN CLERKSVFFULj "
Judith _Town of SoutholdK�OC�y : ApplicationE:?‘.9.(K
Terry, Town Clerk .4
Town Hall, 53095 Main Road `+ Construction
P. O. Box 1179 �. '
Southold, New York 11971 O/!J Alteration
Telephone [ ' 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 q 9
APPLICANT NAME: (� t ) itA
APPLICANT ADDRESS: sr(J 1749 iv, S /
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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: j 4 �O dare . s 0
OWNER MAILING ADDRESS: 60 76 . P3 / '
OWNER PROPERTY ADDRESS: ) 25— 9h/e._ p 1'`•
Soulha d
TELEPHONE NUMBER OF CONTACT PERSON: d�
TAX MAP NO. : Section 7 / Block 2 Lot
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
nature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE: q-c)-3- 52
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