HomeMy WebLinkAboutMilgrim, Stephen r�,�"rj FFO(�c
ELIZABETH A. NEVILLE �1ti Gy Town Hall, 53095 Main Road
TOWN CLERK o * P.O. Box 1179
REGISTRAR OF VITAL STATISTICS �✓ Southold, New York 11971
� Fax(631) 765-6145
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER y_�Q! Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ,rr0 southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4129-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner MILGRIM, STEPHEN
Mailing Address 1 P 0 BOX 1696
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 1255 GOOSE CREEK LANE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 631-765-6285
Tax Map No. section 78.00 block 8 lot 9.000
Cross Street NORTH BAYV I EW
Issue Date: 2/04/02 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK1
TOWNOFSOUTHOLD O�O� �coG Application No./ J
UIZABETH A.NEVILLE,TOWN CLERK '• �'
P.O.BOX 1179
:4 $10.00 - Residential LI
SOUTHOLD,NEW YORK 11971 • $25.00 - Non-Residential
Ory � ��`
Telephone 0 * `�k '�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE .249/02—
OWNER NAME: .1-E,'l�,N M‘t-tAlkiM
OWNER MAILING ADDRESS: 'Q lat.)( 1& '\(e
t
OWNER PROPERTY ADDRESS: I ..'4 Gkap , CREEK- ‘...)+1
SOL)THbLb, Ng tq'11
OWNER TELEPHONE NUMBER: (("! t) 14015 - &a-SS
TAX MAP NO. : Section 7 , Block S Lot
CROSS STREET: 4O fl `N1S.I.0
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential X Non-Residential
LOCATION MAP: Must be attached hereto before permit may be issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
•
/ ignatur of pplicant
RECEIVED BY:
Town Clerk's Office
DATE:
• r CERTIFIED To: SURVEY OF PROPERTY
ti 0� DG 'S AQUEBOGUE.AB§TRACT Corp.• SITUATED A7'
E 1 AMERICAS WHOLESALE LENDER ,
Cp
MICHAEL LYNNE BAYVIEW
CYNTHIA LYNNE TOWN OF SOUTHOL•D
_ —� SUFFOLK COUNTY, NEW YC
� S.C. TAX No. 1000-78-08—i
4ov MARC. 100 299a
x\005 �20' .R.O. �`'�
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^ 'O.:FUZED ALTERATION OR ADDITION 4 Si.'q^I{SSSS•,i
S sover IS A VIOLATION OF • •�i . 9 e'.
N 7209 OF THE NEW YORK STATE : . 1��-e'•
BION LAW. •
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4" oPT' 1 Y, EU
OF THIS SURVEY IMP NOT BEARING
SED SEAL.wo SURVEYOR'S
S,NLL NOTSEAL OR 'BECONSIDERED y7w U�' �•`pRt�JS
A VAUD TRUE COPY. �O A�
1 pRI4 7 9 •j,i• 3' �'� WOOD TIE ^/
.YTEES INDICATED HEREON SHALL RUN 11.7'W, Ftp• \p ly�yy
0 THE PERSON FOR WHOM THE SURVEY �{.•`�
PARED.M D OH NIS BEHALF TO THE ,A OV' WOOS Mt P:-: 'J�
:ONPANY•TON U.MENTAL AGENCY AND c1. '4',Sc!' /i j q,
WSTITVRON USTED HEREON,NW `&�,_`
T.ASSIGNEES OF THE LENDING INS0.-
GUARANTEES ARE NOT TRANSFERABLE 1 i�` "��4,
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pr. /�-, N.Y.S. tic. No. 49668 (T1 i••
Iic5 6OOS.•. C-Mer.. L-14.1C. - 0% - Oct