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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK •
2c 1P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS Fax (516) 765-1823
MARRIAGE OFFICER =: ���' Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER ••,
FREEDOM OF INFORMATION OFFICER -1111 rso.
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1240 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : MARY ANN FLEISCHMAN MILLIGAN
Address 1 : P. O. BOX 1664
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
ADDITION OF A RING AND DOME TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION
INSPECTION REQUIRED.
Name Of Owner MILLIGAN, MARY ANN FLEISCHMAN
Mailing Address 1 P. O. BOX 1664
City St Zip MATTITUCK NY 11952
Property Address 1 1385 PIKE STREET
City St Zip MATTITUCK NY 11952
Tax Map No. section 140.00 block 2 lot 40.000
Cross Street WICKHAM AVENUE
Building Permit Number Cross Reference:
Issue Date: 11/15/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
/ D_.
$k,
JUDITH T. TERRY Down Hall, 53095 Main Road
TOWNCLERK NOV - 7 8994 , ' ' ;; P.O. Box 1179
trs 'Sou'thold, New York 11971
REGISTRAR OF VITAL STATISTICS Va® " Fax (516) 765-1823
MARRIAGE OFFICER _ sj' ..ys�® s•� BLDG.DEPT. Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER = ®1' 9®�i•i. TOWN OF SOUTHOLD
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: November 4, 1994
Transmitted herewith is a copy of application No. A1286 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Mary Ann Fleischman Milligan
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: ZAVATIO INSPECT0®N
APPROVE - „� ,P,EQU ' E®
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells, buildings,
property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
—.ed/
Signatu e
////0A .
Date
OFFICE OF THE TOWN CLERK "
Town of Southold
Judith, 'r,'�. Terry, Town Clerk � � s. Application No./ 612e6
Town H1II, 53095 Main Road Z = Construction
P. 0. Box 1179
Southold, New York 11971 tri ye Alteration
Telephone ����' $10.00 Residential
(516) 765-1801 '- 1
'� $25.00 - Non-Residential
--- ,...110,E
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
1 - i
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. •
Fee $ to
DATE
APPLICANT NAME: PIZ1 1-1 t) N RE-( C �YhA*u m (LL(J4/0
APPLICANT ADDRESS: 1385 1(gE5I r p0 X?)-j( l(o(P4(
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
0-1) it) 1---z) FRSExisr1Ness Poor- ( 0#16--
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: 1}1 f ( ' F i4711,1V 1 (LLf0()
OWNER MAILING ADDRESS: PO (gOX I (0(o
rn 4TT(-T-1)CAC. Ny it cis
OWNER PROPERTY ADDRESS: 132S ST
r-n--I 1D C tc b y l l ct sa—
TELEPHONE NUMBER OF CONTACT PERSON: 51. 27 Lo
TAX MAP NO. : Section /4f OQ 00 Block b o`2 . 00 Lot 09D, 000
CROSS STREET: IA.) l CK 14 fon •j uE
BUILDING PERMIT NUMBER CROSS REFERENCE:
diL:4144191
•
"/ •ii‘n- lure of Appl' .nt
RECEIVED BY:
ed * OVA% Clerk's Office
DATE: $�t n�� RECEIVE®
®31���311 • NOV it 1994
Toren Oak Southorti
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