HomeMy WebLinkAboutMilford C
JUDITH T. TERRY t
: Town Hall, 53095 Main Road
TOWN CLERK G T P.O. Box 1179
REGISTRAR OF VITAL STATISTICS �� Southold, New York 11971
� Fax (516) 765-1823
MARRIAGE OFFICER � ® O� •
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/� Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3178-R Residential X Non-Residential
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Fee $ 10.00 New Existing X
Name Of Owner MILFORD, WILLIAM AND PATRICIA
Mailing Address 1 P. O. BOX 95
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 1200 BAYV I EW ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-5780
Tax Map No. section 70.00 block 7 lot 19.000
Cross Street CLEARVIEW AVENUE
Issue Date: 3/01/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK ocvFFO(,r�'-
Town of Southold • - CQG• Application No. 3/ 7Cr
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Judith T. Terry, Town Clerk
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Town Hall, 53095 Main Road a $10.00 - Residential
P. O. Box 1179trs '—.. ,'' $25.00 - Non-Residential
Southold, New York 11971 O- ® Y
Telephone Q( NO, ''
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE
OWNER NAME: 1` �,L I`ca, q' el C- � Ct' JY1t/ f 0 k 61
OWNER MAILING ADDRESS: i3 G x Rr
SOvitkn SAI 1( itq 71
OWNER PROPERTY ADDRESS: 1 00 2c iJq`C�,7,�,- 1).
Ea(4-141 6 Lei y figJ
OWNER TELEPHONE NUMBER: 7 ,1 S-Z (PC)
TAX MAP NO. : Section 7Q Block 7 Lot
CROSS STREET: 61� n
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing �/ J
Residential 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.)
((II/
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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