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HomeMy WebLinkAboutGrim, Donald & Jeanne (3) IL *pF SOU�,yo ELIZABETH A.NEVILLE '`� l0 j� �� �ea iad TOWN CLERK REGISTRAR,OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER D FREEDOM OF INFORMATION OFFICER Cum�e� io/g� �v et I OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD Organization Name: Permit Number: 164/04 Name: Grim,Donald Address: P. O. Box 300 Cutchogue,NY 11935 City ST Zip: **RENEWAL NOTICE This is to advise you that your Trailer permit will expire on 06/17/2006 Enclosed is a trailer permit application. Complete the application, have your signature notarized and return it to this office with the required fee of$100.00 as soon as possible. Please make your check or money order payable to the "Southold Town Clerk". If your application and fee are not received on or before 6/17/2006 your Permit will be revoked and you will be required to remove the trailer from the premises. Thank you for your cooperation. Very truly yours, Elizabeth A.Neville Southold Town Clerk Enclosure �®��®F soUT�®� ELIZABETH A. NEVILLE ® Town Hall, 53095 Main Road TOWN CLERK P.O. Box 1179 REGISTRAR.OF VITAL STATISTICS G �c Southold, New York 11971 MARRIAGE OFFICER ® �� Fax(631) 765-6145 RECORDS MANAGEMENT OFFICERTelephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER �c®U0�►®,� southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD APPLICATION SINGLE AUTOMOBILE TRAILER Ol� ,SAR Fee: $100 (for maximum of six (6) months) Must be submitted with application. Please check one: / New Application ( ) Renewal �� Permit No. / Received Date: DV ,-�Ao� Issue Date: 1-.4 �1\O6 Expiration Date: -f Name of Applicant: :� 6- 711 l Mailing Address: Telephone No. Applicant is: (1i)Owner ( )Lessee ( )Agent for Owner ( )Agent for Lessee Name of Owner of Premises If owner is corporate, signature and title of duly authorized officer: Number of Occupants & Names: MailingAddress Telephone No.: Employer of Occupant (Name) (Address) (Telephone Number) Property Information Street address of land on which trailer will b loc t d: SCTM#: Existing use and occupancy of premises and intended use a //, upancy of proposed trailer: 1. Existing use and occupancy 2. Intended use and occupancy s 'W/ 3. Period of time trailer is to be located on premises: (/ Lot Size: Front � r� Rear ��� Depth Date of purchase or lease of land Zoning District for premises: Does proposed use violate any zoning ordinance or law? ( )No ( )Yes If yes, explain on separate paper. Trailer Information, > Length - Width Height Registration No/ / Serial No. Method of Sewerage disposal Source of Water Supply '1141 14k Source of Electricity IMPORTANT Cony of survey showing location of existing buildings and existing/proposed trailer must be attached to this application. 1 State of New York Cou ty of Suffolk being duly sworn, deposes and says that thtion; (s)he is the applicant named above and (s) he is authorized to make and file this applica and that all statements contained in this application are true to the best of(her) his knowledge and belief; and that the trailer will be located in the manner set forth in the application filed herewith. (GOL'eA&j1-L/'-�L (Signat re) Sworn to before me this day of , 2 (Notary Public) ' ANY AL TERATM OR A OF SECTION 7209 OF EXCEPT AS PER SECTK HEREW ARE VALV FOi SAD AIAP OR COPIES B! WHOSE 57"TU4E APP CoAff �TTT E US&P a AAKY u1 BROW TO-DA E At d'a '16 F AREi4=7.486 a 01*1 col 5 A E ss • �P ��I��� AFF. 0 0 y3 3z2 • �.�` 5 y5. a,a ` 00 ( G R ti L' Fes• },°" STu1�O Foo 0, f ��- e R p P 6d' 69. E � R O �J1 MAP OF PROPERTY 101. m AT SOUTHOLD TOWN OF SOU7'HOLD e„ SUFFOLK COUNTY NY 1000 - 84 - 01 - 3S1s SCAL& r $ 1 A�4R. �,3004 �— Mar 2,2" (foundatm) / \ JAN 17, 2001 (conc. loundolion 1 ;t J SOUIyo ELIZABETH A. NEVILLE �� l0 Town Hall, 53095 Main Road TOWN CLERK P.O. Box 1179 N Southold,New York 11971 REGISTRAR OF VITAL STATISTICS G � MARRIAGE OFFICER �O Fax(631) 765-6145 RECORDS MANAGEMENT OFFICERl Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER �Y�'+� southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TO: Edward Forrester, Code Enforcement Officer FROM: Bonnie J. Doroski, Deputy Town Clerk DATE: February 23, 2006 RE: Trailer Renewal Please perform an inspection and advise if the trailer permit may be renewed for the following: Applicant: Donald Grim , Trailer Address: CR 48 & Cox Lane, Cutchogue Thank you. L , ELIZABETH A.NEVILLE O�*QF SOUjyOl Q Town Hall, 53095 Main Road TOWN CLERK l�[ P.O. Box 1179 REGISTRAR OF VITAL STATISTICS Southold,New York 11971 MARRIAGE OFFICER p Fax(631) 765-6145 RECORDS AGEMENT OFFICER FREEDOM OF INFORMA ION OFFICER Telephone � s utholdtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD To: Edward Forrester, Code Enforcement Officer From: Linda J. Cooper,Deputy Town Clerk Dated: September 26, 2005 Re: Trailer Renewal Please perform an inspection and advise if the trailer permit may be renewed for the following: Applicant: Donald Grim Trailer Address: CR 48 &Cox Ln., Cutchogue Thank you. - ELIZABETH A.NEVILLE h°Z® �'� Town Hall,53095 Main Road TOWN CLERK C P.O.Box 1179 REGISTRAR OF VITAL STATISTICS � Southold,New York 11971 MARRIAGE OFFICER , • Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER A �a® Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD APPLICATION SINGLE AUTOMOBILE TRAILER OR HOUSE CAR Fee: $100 (for maximum of six (6) months) Must b submitted with application. Please check one: - New Application ( ) renewal j` _ —Permit-N6. / Received Date: eZ3&5�� Issue Date: Expiration Date: Name of Applicant: Mailing Address: Q(� Telephone No. Applicant is: Owner ( )Lessee ( )Agent for Owner (/)Agent for Lessee and� -Name of Owner of PremiseslS;Zzpe- lf owner is corporate, signature and title of duly authorized officer: Number of Occupants &Names: r� MailingAddress Telephone No.: Employer of Occupant (Name) (Address) (Telephone Number) Property Information Street address of land on which trailer will be located: ,M LAY2- SCTM#: Existing use and occupancy of premises and intended useZ/1P ancy of proposed trailer: 1. Existing use and occupancy 2. Intended use and occupancy \ C;le/4( r 3. Period of time trailer is to be located on premises: Lot Size: Front Rear Depth Date of purchase r lease of land Zoning District for premises: Does proposed use violate any zoning ordinance or law? ( No ( )Yes If yes, explain on separate paper. Trailer Informati Length Width Illeight/,////— Registration No. Serial No. Method of Sewerage disposal Source of Water Supply Source of Electricity IMPORTANT Cony of survey showing location of existing buildings and existing/proposed trailer must be attached to this application. State of New York County of Suffolk F6bM� TO--Q1 being duly sworn, deposes and says that that (s)he is the applicant named above and (s) he is authorized to make and file this application; and that all statements contained in this application are true to the best of(her) his knowledge and belief; and that the trailer will be located in the manner set forth in the application filed herewith. (Signat e) Sworn to before me this a� day of (Notary Public) ANY AL TERATM 01;,A OF SECTION 7209 CC i EXCEPT AS PER SEC TK HEREON-ARE VALID F01 SAID MAP OR COPIES BI 60 WHOSE SAWATU4E APP ADDITIONALLY TO COW jv \ c• �� Ate• "T BE USED BY ANY A. 'BROUGH OSDA E At O. AREA=7.485 010 • a •5�pp \Q P -32,20 W. g� 6p e�00' 605 Fes• �o - � F��O. �°Jno-,o�•bar - - V \969 MAP OF PROPER T Y A T SOUTHOLD TOWN OF -SOUTHOLD SUFFOLK COUNTY NY 1000 - 04 - of - 2s1i SCALEr P' = 1 pp' MAR. A3;O 1lJA 2,2000 (foundation) N 17, 2001 (conc. loundolion ` i o��pF SO(/��Ol ELIZABETH A.NEVILLE '` O Town Hall, 53095 Main Road TOWN CLERK Jx[ P.O. Box 1179 - REGISTRAR OF VITAL STATISTICS G Southold, New York 11971 MARRIAGE OFFICER Fax(631) 765-6145 RECORDS MANAGEMENT OFFICEROIyTelephone (631) 765-1800 C FREEDOM OF INFORMATION OFFICER OUsoutholdtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD Organization Name: Permit Number: 164/04 Name: Grim,Donald Address: P. O.Box 300 Cutchogue,NY 11935 City ST Zip: **RENEWAL NOTICE This is to advise you that your Trailer permit will expire on 12/17/2005 Enclosed is a trailer permit application. Complete the application,have your signature notarized and return it to this office with the required fee of$100.00 as soon as possible. Please make your check or money order payable to the "Southold Town Clerk". If your application and,fee are not received on or before 12/17/2005 your Permit will be revoked and you will be required to remove the trailer from the premises. Thank you for your cooperation. Very truly yours, Elizabeth A.Neville Southold Town Clerk Enclosure } Town Of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 09/22/05 Receipt#: 702 Transaction(s): Reference Subtotal 1 1 House Trailer Permit 164/04 $100.00 Check#: 702 Total Paid: $100.00 Name: Grim, Donald P. O. Box 300 Cutchogue, NY 11935 Clerk ID: LINDAC Internal ID: 164/04 Town Of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 09/22/05 Receipt#: 702 Transaction(s): Reference Subtotal 1 1 House Trailer Permit 164/04 $100.00 Check#: 702 Total Paid: $100.00 Grim, Donald P. O. Box 300 Cutchogue, NY 11935 LINDAC Internal ID: 164/04 �AOfr SO!/�y� ELIZABETH A.NEVILLE �� lQ Town Hall, 53095 Main Road TOWN CLERK P.O. Box 1179 REGISTRAR OF VITAL STATISTICS N Southold,New York 11971 MARRIAGE OFFICER # Q Fax(631) 765-6145 RECORDS AGEMENT OFFICER Telephone(631) FREEDOM OF INFORMA ION OFFICER OI�COU ,� � s utho dt wn northfork net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD Organization Name: Permit Number: 164/04 Name: Grim,Donald Address: P.o.Box 300 Cutchogue,NY 11935 City ST Zip: **RENEWAL NOTICE This is to advise you that your Trailer permit will expire on 06/17/2005 Enclosed is a trailer permit application. Complete the application,have your signature notarized and return it to this office with the required fee of$100.00 as soon as possible. Please make your check or money order payable to the "Southold Town Clerk". If your application and fee are not received on or before 6/17/2005 your Permit will be revoked and you will be required to remove the trailer from the premises. Thank you for your cooperation. Very truly yours, Elizabeth A.Neville Southold Town Clerk Enclosure r R-AW-0--ii�At 00' od* DD` IS IAoN-43inj OSO`Ad W. 00` DD' yl en6o4;)in3 GZ001 Ons ilk IJOS Z'RQ RIG oweN ad4j "j ages ad4l'lod sliun aPo3 0 lelol luamaeoidwl . " I anyeA lolsis#Q leraad+ 0 0 001'1. Isla 9v OzAt lod jean, lunowV oP03 :{ela i Bu!pl!nQ ut ( ureal I P401 uoaidueau3 :rale : ac 0 P3 P49N sdosa plot d :s1oclrd. )aumiC gaud-TS 191a0 OFS '06ed *'D 0 30 0 PWI L 3o 1.04isi O 3901 oleS E G VN Poi` OO'rz :Jets aaue Iti -SEG i L :d AN'81160401113 An e8 OOC N08 Citi :611oN 0007 40040S 4004S L96 :06ed owz 4unw 3PPv 1PPv Lcol!l. -*0S OK,1Z ;AunoD t0pD plebotl IMLIN s11oauelloostly 9nPA algexe1 it DQD'tr =a feral. sa>!q�LIr'L.azis PM1 81: N "D6l Z DOOR VPuel sdvj*pla! 1A JJn 3,?OA!{ou pleuo(l'urns loo4oS jor►ililoW loogoS I SId ak"Ov Plo4lnoS 6 out ® pF SOU�,�ol ELIZABETH A.NEVILLE Q Town Hall, 53095 Main Road TOWN CLERK P.O. Box 1179 REGISTRAR OF VITAL STATISTICS Southold, New York 11971 MARRIAGE OFFICER . �� Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER ��� Telephone(631) 765-1800 FREEDOM OF INFORMATION OFFICER COUNTY, southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TRAILER PERMIT Permit Number: 164/04 Date: 09/22/2005 Issued to: Grim, Donald Address: P. O. Box 300 Cutchogue,NY 11935 A permit is hereby issued to locate a single trailer, as follows: License No.: Serial No.: Located at: Cox La& CR 48, Cutchogue SCTM#: 84-1-25.2 Pursuant to application dated 06/17/2005. Expiration Date: 12/17/2005 This renewal permit is granted for a six (6)month period. Elizabeth A.Neville Southold Town Clerk *pF SOUIy ELIZABETH A.NEVILLE �0� �lQ Town Hall, 53095 Main Road TOWN CLERK P,.O: Box 1179 REGISTRAR OF VITAL STATISTICS Southold,New York 11971 MARRIAGE OFFICER aQ@ Fax'(631) 765-6145 RECORDS MANAGEMENT OFFICER Telephone(631) 765-1800 FREEDOM OF INFORMATION OFFICER �vI100m�� southoldtown.northfork.net I i OFFICE OF THE TOWN CLERK I TOWN OF SOUTHOLD I G I TRAILER PERMIT Permit Number:, 164/04 Date:03/16/2005 I t Issued to: Grim,Donald Address: 'P.o. Box 300 k Cutchogue,NY 11935 A permit is hereby issued to locate a single"trailer, as follows: f • License No.: S erial No.: Located at: Cox La&CR 48, Cutchogue { SCTM#: 84-1-25.2 Pursuant to application dated 12/17/2004. Expiration Date: 06/17/2005 I f This renewal permit is granted for a six(6)month period. M14A A.Neville Southold Town Clerk { l I f f i �` SUFFot� Southold Town Hall Annex 54375 Route 25, P.O. Box 1179 EDWARD FORRESTER a Southold,New York 11971-0959 DIRECTOR OF CODE ENFORCEMENT ti 2 Telephone (631) 765-1939 ® Facsimile (631) 765-6639 y ®�� e-mail: ®.( `�►� ed.forrester@town.southold.ny.us TOWN OF SOUTHOLD MEMORANDUM IZECEIVED TO: Linda Cooper, Deputy Town Clerk FROM: Ed Forrester, Director of Code Enforcement MAR 7 2005 DATE: March 4, 2005 � $cq �Y w Wcielk RE: Trailer Permit Renewal, Donald Grim Please be advised the trailer on this property is not affixed to any foundation and is not usable in its present condition. In addition, there is no approved use of the property for which a trailer could be considered accessory to. ��SOFFO��co p G ELIZABETH A.NEVILLE Cz y� Town Hall, 53095 Main Road TOWN CLERK Z P.O. Box 1179 REGISTRAR OF VITAL STATISTICS O Southold, New York 11971 Fax RIAGE OFFICER RECORbl) 765-6145 DS,MANAGEMENT MANAGEMENT OFFICER• y�0• �ap�� Telep one (631) 765-1800 FREEDOM OF INFORMATION OFFICER southoldtown:northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD To: Edward Forrester, Code Enforcement Officer From: Linda J. Cooper,Deputy Town Clerk Dated: February 26, 2005 Re: Grim Trailer Renewal y Donald Grim has filed for his trailer renewal located at Cox Lane and CR 48, Cutchogue (attached). ,Please perform an inspection and advise if the permit may be issued. Thank you. ELIZABETH A.NEVILLE � �� Town Hall, 53095 Main Road ® ` TOWN CLERK P.O. Box 1179 -" �, REGISTRAR OF VITAL STATISTICS Y� Southold, New York 11971 Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER �RIAGE OFFICER �®� ��®� Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD APPLICATION SINGLE AUTOMOBILE TRAILER OR HOUSE CAR Fee: $100 (for maximum of six(6) months) Must be s mitted with application. Please check one: �j New Application ( ) Renewal (�) Permit No. /C�cmo'(�/`/ Received Date: Issue Date: Expiration Date: Name of Applicant: Mailing Address: X lot u Telephone No. / Applicant is: (Awner ( )Lessee ( )Agent for Owner ( )Agent for Lessee Name of Owner of Premises ' Rim '60,VR If owner is corporate, signature and title of duly authorized officer: Number of Occupants & Names: MailingAddress Telephone No.: Employer of Occupant (Name) (Address) (Telephone Number) Property Information Street address of land on which trailer wi}�b��ogd:n pe— SCTM #: Existing use and occupancy of premises and intended use an o pancy of proposed trailer: 1. Existing use and occupancy 2. Intended use and occupancy 51, C Aaw Sig 1P,c'Od'4C, 3. Period of time trailer is to be located on premises: Lot Size: Front Rear Deth P Date of purchase or lease of land Zoning District for premises: ' Does proposed use violate any zoning ordinance or law? ( No ( )Yes If yes, explain on separate paper. Trailer Informa Length T22S .� Width / Height (C Registration No. Serial No. Method of Sewerage disposal Source of Water Supply Source of Electricity IMPORTANT Copy of survey showing location of existing buildings and existing/proposed trailer must be attached to this application. i 7- /9 v State of New York County of Suffolk, > I being duly sworn; deposes and says that that (s)he'is the applicant named above and (s) he is authorized to make and file this application; and that all statements contained in this application are true to the best of(her) his knowledge and belief; and that the trailer will be located in the manner set forth in the application filed herewith. (Signature) worn to before me this A day of �L7 (Notary blit ANY ALTERATION OR ADDITION TO THIS SURVEY IS A V10LAT10N OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. EXWT AS PER SECTION 7209-SUBDIVISION 2. ALL CER jlFICA TIONS HEREON ARE VALID FOR TIO MAP AND COPIES THEREOF ONLY IF SAO MAP OR COPIES BEAR TME"PRESSED SEAL of THE SURVEYOR - 6� sWHOSE SAWA TUNE APPEARS HEREON. �O ADD'pV4LLY TO COMPLY WIII SAID LAW THE TERM AL T£RE BY' �2 �u1? J, S • TSPTCOPY ANOT�SUREYORMAAV PTERMS CH AS ( ECE'AND BROUGHT-TO-DATE'ARE NOT N COMPLIANCE WITH TIE LAW. op' d AREA=7.4858 ACRES Ile �A IDt� \41 Olt \ 80-00 A c•^ 606�6. N8 COQ t^^. �- p P '9 s� 6 ' 1�►1 MAP OF PROPERTY a m AT SOUTHOLD �P�01 N€pro TOWN OF SOUTHOLD S N°o"���'+°��� �. SUFFOLK COUNTY NY 1000 - 04 - 01 - 2601 A LIC. NO. 49618 SCALS l"e 1 ' jK4R 8L.100I S , P.c. !6 AX 163/1 765-1797 INey A 2000 (fowd8tk,,) P. 0. JAN /T,2001 (conc. JOundallon1 110UTHOLD, NY Sl Town Of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 01/26/05 Receipt#: 658 Transaction(s): Reference Subtotal 1 1 House Trailer Permit 164/04 $100.00 Check#: 658 Total Paid: $100.00 Name: Grim, Donald P.o. Box 300 Cutchogue, NY 11935 Clerk ID: BONNIED Internal ID:164/04 - O��g�FFO`�►c®G _ ELIZABETH A.NEVILLE �� y� Town Hall, 53095 Main Road TOWN CLERK co 2 P.O. Box 1179 REGISTRAR OF VITAL STATISTICS O Southold,New York 11971 MARRIAGE OFFICER yijJ • ��� Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER Ol �►� Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD Organization Name: Permit Number: 164/04 Name: Grim,Donald Address: P.o. Box 300 Cutchogue,NY 11935 City ST Zip: * *RENEWAL NOTICE This is to advise you that your Trailer permit will expire on 12/17/2004 Enclosed is a trailer permit application. Complete the application,have your signature notarized and return it to this office with the required fee of$100.00 as soon as possible. Please make your check or money order payable to the"Southold Town Clerk". k If your application and fee are not received on or before 12/17/04 you Permit will be revoked and you will be required to remove the trailer from the premises. Thank you for your cooperation. Very truly yours, Elizabeth A.Neville Southold Town Clerk Enclosure ELIZABETH A.NEVILLE Town Hall, 53095 Main Road o P.O. Box 1179 TOWN CLERK H Southold New York 11971 REGISTRAR OF VITAL STATISTICS G • Fax(631) 765-6145 MARRIAGE OFFICER y4 �aO� Telephone (631) 765-1800 RECORDS MANAGEMENT OFFICER 09 southoldtown.northfork.net FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TRAILER PERMIT Permit Number: 164/04 Date:05/21/2004 Issued to: Grim, Donald Address: Ro. Box 300 Cutchogue,NY 11935 A permit is hereby issued to locate a single trailer, as follows: License No.: Serial No.: Located at: Cox La & CR 48, Cutchogue SCTM#: 84-1-25.2 Pursuant to application dated 06/17/2004. Expiration Date: 12/17/2004 This renewal permit is granted for a six(6) month period. qE beth A. Neville Southold Town Clerk ELIZABETH A.NEVILLEcz� y� Town Hall, 53095 Main Road TOWN CLERKe/* Z P.O. Box 1179 REGISTRAR,OF VITAL STATISTICSO � Southold,New York 11971 MARRIAGE OFFICER yifJ • ��� Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER �l `�� Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TRAILER PERMIT Permit Number: 164/03 Date:05/21/2004 Issued to: Grim,Donald Address: P.o. Box 300 Cutchogue,NY 11935 A permit is hereby issued to locate a single trailer, as follows: License No.: Serial No.: Located at: Cox La& CR 48, Cutchogue SCTM#: 84-1-25.2 Pursuant to application dated 12/17/2003. Expiration Date: 06/17/2004 This renewal permit is granted for a six(6)month period. E10abeth A. Ne ' e Southold Town Clerk • O�OS�EfO�,�coG - ELIZABETH A.NEVILLE a� y� Town Hall, 53095 Main Road cz TOWN CLERK C4 = P.O. Box 1179 REGISTRAR OF VITAL STATISTICSO Southold, New York 11971 MARRIAGE OFFICER ��� Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER ��l `1►� Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TRAILER PERMIT Permit Number: 164 Date:05/21/2004 Issued to: Grim,Donald Address: P.o. Box 300 Cutchogue,NY 11935 A permit is hereby issued to locate a single trailer, as follows: License No.: Serial No.: Located at: Cox La&CR 48, Cutchogue SCTM#: 84-1-25.2 Pursuant to application dated 06/17/2003. Expiration Date: 12/17/2003 This renewal permit is granted for a six(6)month period. EfizMeth A. Neville Southold Town Clerk Town Of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * Date: 05/21/04 Receipt#: 0 Transaction(s): Subtotal 1 House Trailer Permit $100.00 Check#: 612 Total Paid: $100.00 Name: Grim, Donald P.o. Box 300 Cutchogue, NY 11935 Clerk ID: JOYCEW Internal ID:94312 ;Town Of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 05/21/04 Receipt#: 0 Transaction(s): Subtotal 1 House Trailer Permit $100.00 Check#: 612 Total Paid: $10000 7 Name: Grim, Donald P.o. Box 300 Cutchogue, NY 11935 Clerk ID: JOYCEW Internal ID:94312 Town Of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 05/21/04 P Receipt#: 0 Transaction(s): Subtotal 1 House Trailer Permit $100.00 Cash#: 612 Total Paid: $100.00 Name: Grim, Donald P.o. Box 300 Cutchogue, NY 11935 Clerk ID: JOYCEW Internal ID:94313 ELIZABETH A.NEVILLE ��° G'y Town Hall,53095 Main Road TOWN CLERK ® P.O. Box 1179 va Southold,New York 11971 REGISTRAR.OF VITAL STATISTICS 01-0 MARRIAGE OFFICER y � Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER ®d ��® Telephone(631) 765-1800 FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD APPLICATION SINGLE AUTOMOBILE TRAILER OR HOUSE CAR Fee: $100(for maximum of six(6) months) Must be submitted with application. Please check'one: New Application ( ) Renewal Permit No. rl'� Received Date: Issue Date: - j Expiration Date: Name of Applicant: Mailing Address: BOY .000 A fly Telephone No. Applicant is: (Owner ( )Lessee ( )Agent for Owner ( )Agent for Lessee Name of Owner of Premises s aI -f-3e,64n e, 9- t-lm If owner is corporate,signature and title of duly authorized officer: Number of Occupants &Names: MailingAddress Telephone No.: Employer of Occupant (Name) (Address) (Telephone Number) Property Information Street address of land on which trailebe located- ,0 SCTM#: Existing use and occupancy of premises and inten se an o u ancy of pLWosed trailer: 1. Existing use and occupancy 2. Intended use and occupancy 3. Period of time trailer is to be located on premises: -7C 7C Lot Size: Front—? Rear Depth f Date of purchase or lease of land Zoning District for premises: Does proposed use violate any zoning ordinance or law? ( No ( )Yes If yes,explain on separate paper. Trailer Information: Length Width Height Registration N& Serial No. Method of Sewerage disposal Source of Water Supply Source of Electricity IMPORTANT Copy of survey showing location of existing buildings and existing/proposed trailer must be attached to this application. i State of New York County of Suffolk OTQn&L/jbeing duly sworn, deposes and says that that (s)he is'the applicant named above and (s) he is authorized to make and file this application; and that all statements contained in this application are true to the best of(her) his knowledge and belief; and that the trailer will be located in the manner set forth in the application filed herewith. S" I 1�� (Signature SW rn to before me this CI day of 2 CSU of Public) JOYCE M.WILKINS !Votary Public,State of New York No.4952246,Suffolk County Term Expires June 12, ,iL 00`� ®� SUF F®t��® Town Hall, 53095 Route 25 P.O. Box 1179 ® Southold,New York 11971-0959 EDWARD FORRESTER Telephone (631) 765-1939 DIRECTOR OF CODE ENFORCEMENT ® Facsimile (631) 765-1823 e-mail: ®1 �►� ed.forrester@town.southold.ny.us TOWN OF SOUTHOLD RECEIVED MEMORANDUM MAR 2 5 2004 TO: Elizabeth Neville, Town Clerk Southold Town Clerk FROM: Ed Forrester, Director of Code Enforcement DATE: March 25, 2004 RE: Trailer Permit 164, Donald Grim Please be advised no trailer was found on the subject property. r r � � O�OCVFF01�!C J ELIZABETH A.NEVI LLE �� OG'y� Town Hall, 53095 Main Road TOWN CLERKy P.O. Box 1179 REGISTRAR OF VITAL STATISTICS %ftoy • �� Southold,New York 11971 MARRIAGE OFFICER Fax(631) 765-6145 j RECORDS MANAGEMENT OFFICER �Ol .��� Telephone(631) 765-1800 FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net I C OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD Permit No. 51 —Ange &Barbara Bourisquot,Pvt Rd. off Main Rd., Mattituck Permit No. 107—Mary Ciupryk, 390 Hill St.,Mattituck Permit No. 111 —Eugene &Alphenic Martin, w/s Tuthill Rd., Cutchogue Permit No. 129—Bruce M. Vitale, 7280 Sound Ave., Mattituck Permit No. 125 —Joseph Petrauskas, 490 Hill St.,Mattituck Permit No. 149—Vicent Rossi.& Christine Larsen, 1275 Cedar Beach Rd., Southold Permit No. 138—Donald&Jeanne Grim, 11910 Oregon Rd., Cutchogue Permit No. 1-64—Donald Grim, Cox La., &CR 48, Cutchogue Permit No. 167—Timothy&Margaret Hollowell, 1280 Smith Dr., Southold Permit No. 159—Laurel Links Country Club, 6400 Main Rd., Laurel Permit No. 166—Efeyenia Matsis, 435 Inlet Dr., Mattituck Permit No. 78 - Gian Mangieri, Pvt. Rd. off Main Rd., Laurel Permit No. 168—Walter Teresko, 1285 New Suffolk Rd., Cutchogue Permit No. 148—Roy&Joanne Schelin, 8475 Cox La., Cutchogue Permit No. 165—Juan Secaida, 630 Wiggins St., Greenport ELIZABETH A.NEVILLE �� G�� Town Hall, 53095 Main Road TOWN CLERK y P.O.Box 1179 REGISTRAR OF VITAL STATISTICSSouthold, New York 11971 MARRIAGE OFFICER y� ��� Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER �,( �a Telephone(631) 765-1800 FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD To: Ed Forrester, Code Enforcement From: Elizabeth A. Neville, Town Clerk Date: March 2, 2004 Re: Trailer Permit Renewals The Town Board would like all trailer permits to be inspected before they are renewed. Please include the name of the owner and the present occupant. Permit No. 157—Corazzini Asphalt, Inc., 6245 Cox La., Cchogue Permit No. 112—Flora Nurseries, 6900 Wickham Ave.,Mattituck Permit No. 95 -Martin Sidor, Oregon Rd.,Mattituck Permit No. 107—Jacqueline Moeller, C.R. 48, Southold Permit No. 115—Northeast Nurseries, C.R. 48, Cutchogue Permit No. 97 -Frank McBride, Oregon Rd., Cutchogue Permit No. 64 -Zdzislaw Mikolajczyk, John's Rd. off Main Rd., Mattituck Permit No. 41 —John C. Tuthill,Elijah's La.,Mattituck Permit No. 133 —Thomas Wowak,Main Rd., Laurel Permit No. 156—Fine Care Landscaping, 280 Bridge La., Cutchogue ELIZABETH A.NEVILLE �`Z` Gey Town Hall, 53095 Main Road TOWN CLERK p P.O.Box 1179 COD 2 Southold, New York 11971 REGISTRAR,OF VITAL STATISTICS %0_0 R! MARRIAGE OPPICEA y �`� Fax(631) 765-6145.. RECORDS MANAGEMENT OFFICER �f� �S Telephone(631) 765-1800 FREEDOM OF INFORMATION OFFICER '( southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD To: Mike Verity, Building Department From: Betty Neville Date: May 15, 2003 Re: Trailer Permit No. 164—Donald J. Grim As you know, the Town Board would like all trailer permits to be inspected before they are renewed. This permit will expire on June 17, 2003. The location is on Cox Lane and CR 48, Cutchogue. Please include the name of the owner and the present occupant. i q' a - a O��S�FFO(�►CO ELIZABETH A. NEVILLE _� Gy� Town Hall, 53095 Main Road TOWN CLERKco Z P.O. Box 1179 REGISTRAR,OF VITAL STATISTICS � � Southold, New York 11971 MARRIAGE OFFICER gi �� Fax (631) 765-6145 RECORDS MANAGEMENT OFFICER ��l ��� Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SINGLE TRAILER OR HOUSECAR LOCATION RENEWAL PERMIT Permit No. 164 Date January 17, 2003 Issued to Donald J. Grim Address P.O. Box 300 Cutchogue, NY 11935 A renewal permit is hereby issued for the location of a single trailer/bousmar at Cox Lane 6 C. R. 48, Cuthcoque pursuant to application dated 8/27/2002 This renewal permit is granted for a six (6) month period. Expiration date June 17, 2003 Elizabeth A. Neville Southold Town Clerk . . ' � ' 5 ' Size of lot: Front ......... ����.......................Rear ..... ........ Depth __7//)/).............. ` d Dote of purchase or lease of land .. ......... 7 Zone o, use district in which premises are situated u Does proposed use ,io|om any zoning low, ordinance n, regulation? ......�].0................................... 9 o Method of Sewerage disposal -------._----------------' ' b Source ofWater Supply --' � //��~ �—,,--___— _----_--''_--._— �� .—���� c Source of Electricity ----- _ ri� -----'_'-----'—_----_—_' PLOT DIAGRAM Locate clearly and distinctly allbuildings, whether rn ' sions from property lines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. Indicate clearly location of proposed trailer on prem ises, showing distances from all buildings and property lines. ' ' — --- STATE OF NeWvomK \ COUNTY OF sun�uK /� ____—_--�-_—�-----------..--.---.. being duly sworn, deposes and says that he is the applicant named above. He is the ____^..(� vi V-\ v~~' (owner o,���°--- '----''' of said owner or owners,and is duly authorized to make and file this application; and that all statements or agent) contained in this application are true to the best of his knowledge and belief; and that the trailer will be located in the manner set forth in the application filed herewith.Sworn to before me this ' ........... day of ^' � . ----'—�'—�'~~�°—_------`"~'"~^~�^~—�'^'�^—��'+ .--_. (Sig t —.----.�.' -----_. | . — O�OS�FFO(,�c ELIZABETH A. NEVILLE �� OGy� Town Hall, 53095 Main Road TOWN CLERK o -'� P.O. Box 1179 ti ae REGISTRAR,OF VITAL STATISTICS UU-1 Southold, New York 11971 MARRIAGE OFFICER y �� Fax (631) 765-6145 RECORDS MANAGEMENT OFFICER '/Q! �a� Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 850 OF 2002 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON DECEMBER 17,2002: RESOLVED that the Town Board of the Town of Southold hereby grants permission to Donald Grimm to locate a temporary house trailer for the purpose of a night watchman/security trailer at his farmstand located at Cox Lane and CR48, Cutchogue,New York, for a six (6) month period of time. Elizabeth A. Neville Southold Town Clerk V -850 RESOLUTION - DECEMBER 17,2002 RESOLVED that the Town Board of the Town of Southold hereby grants permission to Donald Grimm to locate a temporary house trailer for the purpose of a night watchman/security trailer at his farmstand located at Cox Lane and CR48, Cutchogue,New York,for a six(6) month period of time. .lAti ELIZABETH A.NEVILLE �� Town Hall, 53095 Main Road TOWN CLERK P.O. Box 1179 REGISTRAR OF VITAL STATISTICS Southold, New York 11971 MARRIAGE OFFICERFax(631) 765-6145 RECORDS MANAGEMENT OFFICER ®� ��®� Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 850 OF 2002 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON DECEMBER 17, 2002: RESOLVED that the Town Board of the Town of Southold hereby grants permission to Donald Grimm to locate a temporary house trailer for the purpose of a night watchman/security trailer at his farmstand located at Cox Lane and CR48, Cutchogue,New York, for a six (6)month period of time. S t Elizabeth A. Neville Southold Town Clerk V -850 RESOLUTION - DECEMBER 17,2002 RESOLVED that the Town Board of the Town of Southold hereby grants permission to Donald Grimm to locate a temporary house trailer for the purpose of a night watchman/security trailer at his farmstand located at Cox Lane and CR48, Cutchogue,New York, for a six(6) month period of time. IV 6 DECEMBER 17, 2002 FOR DISCUSSION Request for trailer for security reasons Donald Grimm Farmstand at Cox Lane and CR 48, Cutchogue ELIZABETH A.NEVILLE _� 'y� Town Hall, 53695 Main Road TOWN CLERKy - P.O. Box 1179 REGISTRAR OF VITAL STATISTICS � n2ir Southold, New York 11971 MARRIAGE OFFICER Fax(631)'765-6145 RECORDS MANAGEMENT OFFICER "'/Ql ��� Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD To: Supervisor Horton and Town Board Members From: Town Clerk Elizabeth Neville Re: Donald Grimm trailer permit application Date: December 16, 2002 Donald Grimm brought in the attached two(2)police reports in support of his trailer; application. He asks that the Town Board re-consider granting his application. 3, 1 Agency 2 Dwisw pct 3;�;�)tY 7^ y�N ✓w '"' Lys S Case No Tclent.�� // / @ "L�!r� 1� .YS=:,: Ao3 ORIWbri9 `"l©1 _ � taut' )1 ii NYC)) �jf � SuPP t 7.ReportDay Date � I O 9 Report e ort�nine 10 Day 1 7 DateIJ s I Q� 13 Day 14 1(:Date y r 15 Time meam0,y12 Tt 16.Incident Ty 17 Business Name 18.Weapon(s) i A 19 Incident Address(Street NO,Street Name Bldg No,LLA��pt No) 20 City,State,Zip(❑C ❑T� j❑V) 21 Location Code B C_4 L /" Y tl2yf e D t r+,par r{,.u'.4n� L S u s.zui c� y s,i;`jy"t,�•k')k,p:.zy.+ � FFz`1807'u'x 6JJ A, > e>'� i SU9e3: 4� t%�6EG~, � r (jF J ' , s u r_t�q k ,.r`t 23 NO of Victims {,. _ ,d a _3'. 6' r ` a.4X.tii .�' 1t�< - �S)�+c.,' "k',i;_=. <<i a."�t'S' C 2 24.No of Suspects DL// j +a 3 missg] ��,•?.��t:'E+,rn"~ .,..h<<)'.;.t r"" r,.Y<•-r „�,ryr•-;i);t ra3`+`i..'+•'r"S4r^-.a's«r-x 1 �ax.,-^.>^2F:xr ;V"•s, )isT CO.=Co�ta+ja yaYpT ;OtRerP,l a In eivr y� tom•-� 1 P � �P i3un 1, ¢v;L ,�!N,��erio`ti�l�(epOrttng',WL'=_�tne'sf;W1=,No•It�t�Sv(es�e211%)r'=,Viitt,� .',I,`Z,f, 26 Victim also complainant ❑Y❑N ...�.s,+.u^s>ctx�.+r--: _:�.,.rF.�_,v. -:,,:^...m,�.:+<.rcr..,-,.-,,,. ��-.�,eet.i.n-...:.�..�,,.,1e.•. __s.�.,.t E Y7•¢', fly it'.!/?r;}'* gMEi(''St l$SY;P%JIDC!L'E;jTITI`E)'S;a,4',''° `,7 atG of"7f;,LSTREETi'NO:;;STFCEET.-t(APJIE,BI.DGrN ;=/4PT�N ,GIT'!`�•,STA C��r'Qn "k:�"'�" cit•''" 7 ¢ .1,G —'ia � . S;r`=f'R:+r�+,.✓� 4 W t.�,� ielep�ioA 0,:, ,r✓ oZ 'c -si�•.ss5'r1°-r,:A _+�J"Y's :+ :rb',r . w .,r-=firth`h'ev 'z {»7^`'!r„ "+fi.. r.z `Y=r�: ,�c� =``,+°�_•: ': �a�. Bi i"!Nt"s F 'Ud Cc ��+1-_4, bow(d 5G lk , ke( L C 4 Je 4l ,, rt -r Ws13kt 7Z L/6 tvff itu,,N 5 G q ty Rt SIDFNCE BUS1NLSS H RLSlF;NCE � i BUYNESS 1 -/ RESIDENCE a 27.Date of Birth 28.Age 29 Sex 30 Race 31 Ethnic 32 Handicap 33 Residence Status ❑Temp Res -Foreign Nat Mo Da vi ❑ M ❑ F ❑White❑ Black❑Other ❑ Hispanic C] Unk. 11 Yes ❑ Resident []Tourist❑Student Other 1 f ❑U ❑Indian❑Asian❑Unk. ❑Nop-Hispanic 13 No ❑Commuter[]Military ❑Homeless❑Unk ^S h”yr le 1. 34.Type/No 35.Name(Last,First,Middle) 36 Alias/Nickname/Maiden Name(Last,First,Middle) 37.Apparent Condition K TAB(k V ❑ Impaired Alco DrugsS CI Unk E] Impai ed ❑Ind/III a❑IApp Norm { 38.Address(Street No,Street Name,Bldg No,Apt No. State,Zip) 39 Phone No ❑ Home 40.Social Security No L � ❑ Work 41 Date of Birth 42 Age 1 43 Sex 44.Race 45 Ethnic 46 Skin 47 Occupation Mo Dat ,: C] M ❑ F ❑ White C] Black C]other ❑Hispanic❑ Unk. C] Light []Dark [IUnk. M. U (]Indian ❑Asian❑ Unk ❑Non-Hispanic ❑Medium ❑Other P 48 Height 49 weight 50 Hair St Eyes 52 Glasses 53 Build 54 Employer/School 5S Address cIt i .. E] Yes E] Contacts ❑Small C]Large N ❑No C]Medium A� 56.ScarslMarksrTattoos(Descnbe) 57 Mise n 0y f .^-l,.%7'y'_ .':ei-', i.'3+� �" Vittim_oc.; '.n'P7bperty 4,ProI ',, Quanu4yl' s �Ma�se oigii a �^ r' �.., � sS x �^' P i �. :�ta�liS-a:'.rot•�r-�T PC. Measure EDF Y ","`' Mode .l, 4 'i� t:;f"Desch t'on y+,;,,r, /• n 5�, r,'; t.a;. •S�ri;(.No: ;n # '"rwu i .,Value f 7 AB LC j st S9.Vehicle 60.License Plate No Full C] 61 State 62 Exp Yr 63 Plate Type 64,Value g .a: Status Partial❑ 1 1 ly TABLE:/ I I I § , 65 Veh Yr. 66 Make 67 Model 68 Style 69 VIN `! r .r�u+4�T4l, 70 Color(s) 71 Towed By 72 Vehicle Notes x'� To •73. U�r�M ✓C U.4) -,)C.fry eq (.J4.54(/ Q6"'I c ♦r 1je,-C dc'A ed l "etr- F G-;� .� wt'�'��. -� �'• Ili ® 12 a�ys�C�[C5 7 p OG a, lotal ,j. X74 Inquiries(Check all that apply) 75 NYSPIN Message No 76 Complainant Signature .+„ ❑DMV ❑Want/Warrant ❑Scofflaw -+s... �y ❑Crim History ❑Stolen Property ❑Other =s = &? 77.Reporting Offi Signature(Include Rank) 78 IDrA(oi ', 79.Su icor i Signat (Includ R nk) B CQ� 84. ` 3 a ge 81.Status []Open ❑Closed(If Closed,check box below) ❑Unfounded 82. a s Oat 83 NotifiedrTOT of ❑Vict.Refused to Coop ❑Arrest ❑Pros Declined ❑Warrant Advised o I Z 16 'F ❑CBI ❑Juv -No Custody ❑Arrest-Juv ❑Offender Dead ❑Extrad Declin []Unknown ��,(j C! Pages DCJS-3205 (2/97 'FALSE STATEMENTS ARE PUNISHABLE AS A CRIME,PURSUANT TO THE NEW YORK STATE PENAL LAW. 1.A 'ncy 2 1 /Precinct T" '`� 13 ORI 9 5 aseN''(�' On 6 Incl entNo 1 b(/`�I^ I5"Im" KCP;�ORy1 NY �i S ❑ Supp 7 L 7 Report Day 8 Date 9 Report Time s°dGt'� ` Illµ `- U�"���+ a �'ti fs 10 Day Date 12 TimelcT. redf13 Day 14 Date 15 Tin - a' ?%'b 02, l3y ' 16 Incid nt TypAe 17 Business Name 18 Weapon(s) y� nn Ca. 19 Incident dddress(Street No, treet N ,Bldg tZ, No) 20 City tate ip( C ❑ T ❑V) 21 Location Code ,icy �- -x �',� R swa -, -•�. -'troVis may' #,�, mcag �r,wr,.'Yc*. G 4"r ierx•ry ti, '2t=„F `i0^s':rc iCA3ECT�0 ,,a�/ SU6.1 SCI,,N ." 0;3QEGf '• u xnf( IW <aORstYSE Fri ^ CS o of Vi ms C � ����..':�7+'Fi.,•-- �"�.�y.'K' g);Y 23 N 2 24 No of Suspects r, 3 D f {�'+»r,,. "ii:-C•m: `�.',,.' :f•�"l1i i',tw' x t9.."esli EdA�X..ir'!a..'ii`ag�;. i:.Yv 'c��; 3•u„".5•r„ rs:-w":s k�r ter._a&`--^?�•aec"i 2 .Peridi%T CU-`'Coin ant`OT=.OtherFlya -;.ir .a �Y, ,..-��:a,- ',.,�`_•hc-.,r;.....,,,t,,,�,erorf�I�erviewedtQR"=Person 11 WW 26 Victim also complainant N ST- PEMO� ”{"S,YN ME(LgS7 FI�iSi;rMiDDiE TITLE) rUateof•;r-'STR�E�NO?,STREET:NA E eLDG NOxrAP rN STr, E i%� ? c• [i .r x a Y s� v, r_Yi^"t `�i c "°'r X , re, 'Tele hone N .xy''''2�F 'SFS„•..r.,4�5�•,sS'7,it3�Y.c,,r'.��,fn�".j�'., kro.;; ...-.f,?; 0 e O. N W , - t ewa� o� Sb v pt 1 - G i• ZF S,L,Eti C° ig+✓ 3iiS:LESS •dF ,i S1DEN:C= 1 j27.Date of Birth 28 Age 29 Sex 30 Race 31 Ethnic 32 Handicap 33 Residence Status ❑Temp Res -Foreign Nat / Nio Day Yr ❑ M ❑ F ❑ White❑ Black❑Other E] Hispanic[I Unk ❑ Yes C] Resident []Tourist E] Other y ❑U ❑Indian❑Asian❑Unk C]Non-Hispanic ❑No C]Commuter❑Military [IHomePeess❑Unk 34 T /No 35 Name Last,First,Middle Type/No ( ) 36 AliaslNickname/Maiden Name(Last,First,Middle) 37 Apparent Condition K Z Q Impaired Drugs ❑ Mental Dis ❑Unk C) !L60,0 ❑Impaired Alco ❑In!/111❑App Norm ut cc LU' 38 Address(Street No,Street Name,Bldg No,Apt No.City,State,Zip) 39 Phone No 40 Social Security No - a ❑ Home L F., ❑ Work J\ 41 Date of Birth 42 Age 43 Sex 44.Race 45 Ethnic 46 Skin 47 Occupation NuT NA') J x, Y, ❑ M ❑ F ❑ White❑ Black❑Other Hispanic Unk M � ❑ ❑ ❑ light ❑Dark ❑Unk- _ ' N00 ❑U ❑Indian❑Asian❑Unk. ❑Non-Hispanic []Medium❑Other 48 Height 49 Weight 50 Hair 51 Eyes 52 Glasses 53 Build 54 Employer/School 55 Address ❑ Yes❑ Contacts [-]Small []Large N - ❑ No C]Medium -r— S6. S6.Scars/Marks/Tattoos(Describe) 57 Misc 'l ''' _=:i�+v. "tfN9 ;� a W,:S�;;.i,,"K2i ti' r, t. _-- •2.i Q aria y�` ,h:- a eor- y ,.x " "k r "xF'c: r,'t 3Cr"S.- '': /.iw^::]�K.F r., r 1 ,. �Y-f ,xti<s�"�.�.-`� •4 ft A=` %'i'trti�"/'' ftp-aia` �;� Y,tl� Y S aia Sta'tu 1 _tY pe: y:Mea£Yir J)rd T' :; ni;Model Y :'•;,a=�e�i9l,tVo '= •, T Descriq�tio7i;z;we'. u ;c r TABLES TAB, T ._BLE iJ 'AEt r" t UC Wx },!i ;. 59 Vehicle 60 License Plate No Full❑ 61 State 62 Exp Yr 63 Plate Type 64 Value ¢% Status ❑ � �� TABLE W Partial 65 Veh.Yr 66.Make 67 Model 68.Style 69 VIN K`" " z , 70 Color(s) 71 Towed By 72 Vehicle Notes ,1 7. E'IrniY4 u X73. oytaj d lS r 1 V✓.\ ! C 0-nn iv-hl ,� a r L L�a-1- 'J 6. TOC 74.Inquiries(Check all that apply) 75 NYSPIN Message No 76 Complainant Signature '-' BFi +y ❑ DMV ❑Want/Warrant ❑ Scofflaw ❑Crim.Hist ❑Stolen Property ❑Other r�r —IN 7 R in fficer Signa (In u e ank) 84. Tz 79 pervisor's ig tar (In ude Ra k) 60 ID No ' Gam. �. a9 N4^r 8 Status ❑Open Closed(If Closed,check box below) ❑Unfounded 82 Status Date 83 NotifiedITOT of ❑Vict R i ed to Coop ❑Arrest ❑Pros Declined ❑Warrant Advised d� Juv.-No Custody ❑Arrest-Juv ❑Offender Dead ❑Extrad Declin ❑Unknown D� (�v Pag DCJS-3205 /97) 'FALSE STATEMENTS ARE PUNISHABLE AS A CRIME,PURSUANT TO THE NEW YORK STATE PFNAI I AW TOWN OF SOUTHOLD TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ..................................... 19..... ..Permit No. ................ APPLICATION FOR LOCATION OF SINGLE AUTOMOBILE TRAILER OR HOUSE CAR, OUTSIDE OF TOURIST CAMP. 7100p— Date .....�I.z�................. . Instructions a. This application must be completely filled in by typewriter or in Ink and submit one copy to the Town Clerk. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property and proposed location of trailer must be drawn on the diagram which is part of this application. c. Upon approval of this application, the Town Board will Issue a trailer permit to the applicant. Such \ permit shall be kept on the premises available for inspection d. No trailer shall be occupied or used in whole or In part for any purpose whatever other than specified in permit. Application is hereby made to the Town Board for the issuance of a Trailer Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York,and other applicable Laws, Ordinances or Regulations. The applicant agrees to comply with all applicable laws, ordinances and regulations. ..................................................................................... (Signature of applicant) (Add ress) u State whether applicant is owner, lessee or agent..... .......................................................... Name of Owner of premises . .A.??. C�.. ..TP t•)h. ... Y..;i,- ......................................... . ff applicant is corporate, signature of duly authorized officer �....N..a................................................................. (Name nd title of corporate officer) 1. Location of land on which proposed trailer will be located .... ......................... Street and number ....N.,�......�',�.rr..���.....�?.X...La:rhe.:E:...Cn. ..-�-1/.i................:�.�............. 2. State existing use and occupancy of*pr(emises and intended use and occupancy of proposed t"railer; V , a. Existing use and occupancy ......� .�ne...... ............................................................................... b. Intended use and occupancy .....,............................... c. Period of time trailer is to be located on premises .................................................................... 3. Fee ............................................ (To be paid on filing application) �(? -. 4 Dimensions of trailer, length ......... .. r .........width ......j. —............L..,,height ....�.. .......:......_.. Registration Number ...L)V,.�ov.�....... .Serial Number ...Q.ka1�!:.!.ov.'jn. ....................... I ,' tet' � w �• .• � i ler�r+1{Y'1!'f LSI 17"x.�r I �I� � I II � I li � 1 i I .N it �i � 4' i �+'0 t�dr � �•, .�'! � �/� TOWN OF SOUTHOLD TOWN CLERK'S 'OFFICE SOUTHOLD, N. Y. Approved .................................. .. 19........Permit No. ................ APPLICATION FOR LOCATION OF SINGLE AUTOMOBILE TRAILER OR HOUSE CAR, OUTSIDE OF TOURIST CAMP. I Date ..... J........................... Instructions a. This application must be completely filled in by typewriter or in ink and submit- One copy to the Town Clerk. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property and proposed location of trailer must be drawn on the diagram which is part of this application. c. Upon approval of this application, the Town Board will issue a trailer permit to the applicant. Such permit shall be kept on the premises available for inspection. d. No trailer shall be occupied or used in whole or in part for any purpose whatever other than specified in permit. Application is hereby made to the Town Board for the issuance of a Trailer Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations. The applicant agrees to comply with all applicable laws, ordinances and regulations. ..................................................................................... (Signature of applicant) Pf v 6 Ixg... ............ (Address) State whether applicant is owner, lessee or agent..... .......................................................... Name of Owner of premises .... .................................................. . (f applicant is corporate, signature of duly authorized officer NameJ6nd ttitle of cor orate officer) ( P 1. Location of land on which proposed trailer will be located .... .......................... Street and number ....N.I);—......,�:'.mgr.....C?.X.... �'? .:t ...S.r) ?: 1 ... .....`' .4�............. 2. State existing use and occupancy of ypr(emises and intended use and occupancy of proposed trailer: a. Existing use and occupancy ......1v.d.!e....................................................................................... b. Intended use and occupancy ..3.e'Q.S4yi,&...—&.ryn....VJ.U.Yk<!Y..".................................... c. Period of time trailer is to be located on premises ...................................................................... 3. Fee ............................................ (To be paid on filing application) 4. Dimensions of trailer, length ....../:0. ...........width ........D �............... height ....1... .r.............. Registration Number ...�,1�'..�:� ........ .Serial Number ...v. lam! .!.U1 ....................... 5. Size of lot: Front ........ ...................Rear .......... ........ Depth .......`7100...— .r..... 6. Date of purchase or lease of land ..�llt'�-l�l 5�' .........l. c��................. ................................. 7. Zone or use district in which premises are situated 8. Does proposed use violate any zoning law, ordinance or regulation? ...... .1 (/ ..................................... 4 ' 9. a. Method of Sewerage disposal ..... ... .............................................................................. b. Source of Water Supply ........ .��.r1.✓a4e............................................................................. c. Source of Electricity ..................rl..k. ............................................................................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimen- sions from property lines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. Indicate clearly location of proposed trailer on prem- ises, showing distances from all buildings and property lines. STATE OF NEW YORK COUNTY OF SUFFOLK `ss. r> .........�p.....c` ............................YI.✓t-............................... being duly sworn, deposes and says that he is the applicant named above. He is the .....................U�...Vj.�..e.. (owner or lessee or agent) of said owner or owners, and is duly authorized to make and file this application; and that all statements contained in this application are true to the best of his knowledge and belief; and that the trailer will be located in the manner set forth in the application filed herewith. Sworn to before me this ...Q?..l..4r........... day of .[�rQ. -.................. .. fi91.. � 1.. .... .. .. ............ (Sig at re) �OiQPublic) LINDA J.COOPER Notary Public,State of New York No.4822563,Suffolk County 0 Tnrvn Exoji-as Deceirtoar 31, i i .� a aua In � i• p eu. � �� ,� � i rl� it r �4.LT...dra V603W1��4k14Ldp.0 i • 1 o \ ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION /> OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. EXCEPT AS PER SECTION 7209 -SUBOIVISION 2. ALL CERTIFICATIONS HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF / SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR O WHOSE SIGNAMM APPEARS HEREON. 06 \ c• �i s �0 ADDITIONALLY TO COMPLY WITH SAID LAW THE TERM ALTERED BY' �Z 76, MUST BE USED BY ANY AND ALL SURVEYORS UTILlaVG A COPY u`� OF ANOTHER SURVEYORS MAP. TERMS SUCH AS •WSPECTED'AND ' BROUGHT-TO-DATE'ARE NOT AW COMPLIANCE WITH THE LAW. �0 a � AREA =7.4658 ACRES 0*1 ` 0 � P 11 FF' ' h�h�oo �`e 7� 3 20• W , �• 6� S•\ o eo o. boy 5y' q.8 ( GR F3�O �oJ�y b�Y colt, n°D o� QI{ o P 0 ti MAP OF PROPERTY , e^,� AT SOUTHOLD �P�EOF " wyo TOWN OF SOUTHOLD 5 °�"� ��`g��•�� SUFFOLK COUNTY NY fps ; 1000 - 84 - 01 - Z5 N. .S. LIC. NO. 49618 SCALS 1" a 1 - `� P.C y A44R A, (6 S AX (63() 765 - 1797 May 2,2000 (foundation) � P. o. JAN. l7, 2001 (conc. foundation ) 1230SOUTHOER NEY. STREET