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ELIZABETH A. NEVILLE #A; Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ,� Southold, New York 11971
MARRIAGE OFFICER
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RECORDS O ��,1� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER ®� ,�ss22,, s� �iie Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER — ED 0
OFFICE OF THE TOWN CLERK
SOUTHOLD VIVAWYTENIARERTD115110SAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2660 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : MORRIS CESSPOOL
Address 1 : 2760 YENNECOTT DRIVE
City St Zip SOUTHOLD NY 11971
Descripton of Proposed Construction or Alteration
ADDITION TO EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES.
EXCAVATION INSPECTION REQUIRED.
Name Of Owner MILGRIM, STEPHEN
Mailing Address 1 1255 GOOSE CREEK LANE
City St Zip SOUTHOLD NY 11971
Property Address 1 1255 GOOSE CREEK LANE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 78.00 block 8 lot 9.000
Cross Street NORTH BAYVIEW ROAD
Building Permit Number Cross Reference:
Issue Date: 9/25/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLEt� �,s � Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS car ",y Zs �� Southold, New York 11971
MARRIAGE OFFICER � Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER ® A 0Telephone (631) 765-1800
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FREEDOM OF INFORMATION OFFICER '_1 i *01
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: September 18, 2001
Transmitted herewith is a copy of application No. 2750 for a Cesspool/Septic Tank Construction
Permit submitted by:
Morris Cesspool for Stephen Milgrim
Please review the application and location map and advise if the project has received Suffolk County
Health Department approval and if this office may issue the permit.
Please complete the form below and return it to me.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
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Comments:
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Signature
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Dated
OFFICE OF THE TOWN CLERK �' , �FFO[k�'
TOWN OF SOUTHOLD , �OS Q% Application No. � ?
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RTABETH A.NEVE 7.F,TOWN CLERK �.
P.O.BOX 1179 . j ; Construction v
SOUTHOLD,NEW YORK 11971 vT
Alteration
Telephone 0, •��0 ��Q��'�, $10.00 -Residential
(631) 765-1800 -_ 1 4d 0 $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
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for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE =�kJe� P v I
APPLICANT NAME: (7� i�° �- �,'` i /
APPLICANT ADDRESS: ?'V %l// r-
SEPTIC CESSPOOL A
DESCRIPTION IF `ROPOSED CONSTRUCTION OR ALTERATION
- �.
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: •
OWNER OF PROPERTY: ,47fIj(/ #
OWNER MAILING ADDRESS: / f � eddf(
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OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: XX- 92
TAX MAP NO. : Section 7eP
Block if Lot 9
. CROSS STREET: /' .O A)
BUILDING PERMIT NUMBER CROSS REFERENCE:
9D- 6-71/6A4 A/1-1-1:' •
Signature of Applicant
RECEIVED BY: h
To n Clerk's Office
DATE: / �Q' (
CERTIFIED To: SURVEY OF PROPER`["
0c•0 AQUEBOGUE ABSTRACT Corp. SITUATED A7'
OgCpls'i
MICHAEL SLYNNOLESALE SLENDER • I3AYVIEW
CYNTHIA LYNNE TOWN OF SOUTHOLD
— - SUFFOLK COUNTY, NEW YC
' S,C. TAX No. 10003-78-08—�
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0v MARCH 30, 1994
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