HomeMy WebLinkAboutMilligan JUDITH T. TERRY ' w .
•Y" Town Hall, 53095 Main Road
TOWN CLERK ' ,J P.O. Box 1 179
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REGISTRAR OF VITAL STATISTICS W Southold, New York 11971
MARRIAGE OFFICER + t ;J Fax (516) 765-1823
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. 1588-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner MILLIGAN , JOHN
Mailing Address 1 974 AQUAMARINE DRIVE
Mailing Address 2
City St Zip GULF BREEZE FL 32561-0000
Property Address 1 TRUMANS PATH, BOX 375
Property Address 2
City St Zip EAST MARION NY 11939-0000
Owner Telephone No. 904-932-1668
Tax Map No. section 31 .00 block 12 lot 2.000
Cross Street SOUND AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 1/17/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK ���FF(]
Town of Southold X05 - ,"i 4 Application No. J5'O
Judith T. Terry, Town Clerk ` e w 'N ="4_.." -) _
Town Hall, 53095 Main Road , 4-. $10.00 Residential
P. O. Box 1179 cry 1.4!:".
$25.00 - Non-Residential
Southold, New York 11971 O "r ;'�" K $
Telephone Q( Nge "
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ AI
////
DATE
'OWNER NAME: (4'4 ://0b ,-,50//- •
•
OWNER MAILING ADDRESS: ?7V ,- ,, ' q-z,;-e Ap-e.
OWNER--PROPERTY ADDRESS: �ipvf., jgJA 524—
es-7-M-77~047 /.r1 //91,
OWNER TELEPHONE NUMBER: 76,7-- 9 J 2– /‘
TAX MAP NO. : Section Block Lot
CROSS STREET: •` /GC!/ 2 firr'ae •
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing X
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: ai2C,17 /7-7&
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.)
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Signa ure o Applicant
RECEIVED BY:
Town Clerk's Office
DATE: i