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JUDITH T. TERRY - L Town Hall, 53095 Main Road
TOWN CLERK v P.O. Box 1179 -
REGISTRAR OF VITAL STATISTICS If �� Southold, New York 11971
t. i� Fax (516) 765-1823
MARRIAGE OFFICER ® ,
',2/®1 �1�®••� 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. 1026 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 8' X 8' LEACHING POOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. EXCAVATION INSPECTION REQUIRED.
Name Of Owner WYSOCKI, WILLIAM JR.
Mailing Address 1 845 ORCHARD STREET
City St Zip ORIENT NY 11957
Property Address 1 845 ORCHARD STREET
City St Zip ORIENT NY 11957
Tax Map No. section 25.00 block 2 lot 17.003
Cross Street VILLAGE LANE
Building Permit Number Cross Reference:
Issue Date: 7/30/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
JUDITH T. TERRY1: Town Hall, 53095 Main Road
TOWN CLERK , t P.O. Box 1179
REGISTRAR OF VITAL STATISTICS r
&f Southold, New York 11971
MARRIAGE OFFICER ' 41• Fax (516) 765-1823
-® i� Telephone (516) 765-1801
ED 11 -iiif
rdEC r=y'M1 ri\OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD JUL 1 5 1993 11 11
TO: Southold Town Building Department BLDG. DEPT.
TOWN OF SOUTHOLD
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: July 15, 1993
Transmitted herewith is a copy of application No. A1056 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Gary Tabor for William Wysocki Jr.
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.
dew
Linda J. Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the following recommendation:
APPROVE
DISAPPROVE - -
COMMENTS:
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Signature
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Date
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OFFICE OF THE TOWN CLERK c0FGL4 Ci
Town of Southold ��•
Application No. f0
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road ` a Construction
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t - �- , (�
P. O. Box 1179 �. :�: �� � J Alteration
Southold, New York 11971 ' ���!
Telephone O t N�; " Residential L�
p
(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 71 / % /7J
APPLICANT NAME: /4f" , 74Z / Qr
(lam
APPLICANT ADDRESS: YO / X64 U/ 5
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' $4- / 1)/S o C
OWNER MAILING ADDRESS: F-V5 a/ S
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: 3 .,01' o 7
TAX MAP NO. : Section Block Lot / 7i J.
CROSS STREET: 7- ✓ 1/4477 e--
BUILDING
BUILDING PERMIT NUMBER CROSS REFERENCE:
nature of Applicant
RECEIVED BY:
mown Clerk's Office
DATE:
JUL 1
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