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Home My WebLink AboutGerdts s :; Town Hall, 53095 Main Road ®� I P.O. Box 1179 .421~ �j �, Southold, New York 11971 JUDITH T.TERRY `=-:. ,Lir�i�' FAX(516)765-1823 TOWN CLERK TELEPHONE(516)765-1801 REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 1456-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner CERDTS, ROBERT H. Mailing Address 1 P. O. BOX 184 Mailing Address 2 City St Zip LAUREL NY 11948-0000 Property Address 1 FRANKLINVILLE ROAD Property Address 2 City St Zip LAUREL NY 11948-0000 Owner Telephone No. 516-298-5087 Tax Map No. section 125.00 block 1 lot 3.000 Cross Street ALDRICH LANE Date Of Last Pump Out 0/00/00 Issue Date: 5/08/90 Judith T. Terry Southold Town Clerk (TOWN SEAL) !. tee 'OFFICE OF THE TOWN CLERK ' " �I�FFO Town of Southold ��r� � o Application No. Judith T. Terry, Town Clerk � %) $10.00 - Residential X Town Hall, 53095 Main Road 8 "` �{, P. O. Box 1179 cry $25.00 - Non-Residential Southold, New York 11971 O 0�,e� Telephone Q( 4 It• (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL - - Op ratiLii-Permit No. Fee $ DATE 4341(40 • OWNER NAME: Q'ge'r2 , eQb--r-s, • OWNER MAILING ADDRESS: -p© L. to V 1 (44-8 OWNER PROPERTY ADDRESS: ''F au IkAir L gat_ K .) tt4416 • OWNER TELEPHONE NUMBER: ,.Q42j —se3s7 TAX MAP NO. : Section lag Block _ Lot 5 CROSS STREET: A(`t etc_14 •of TYPE OF SYSTEM: Septic Tank New Existing Cesspool New Existing Residential Non-Residential DATE-OF PREVIOUS PUMP-OUT: • - '- ------- . L ---- - - _ 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.) t4- Signature of Applicant RECEIVED BY: Town Clerk's Office DATE: G t• l.olire' S 59 90 / , e r 1 y 0.coo. 0 r for"' c ' ' —' n0� 321E. / N o 0 N, N 0 ` i' 3 1 O_ CO • OFR ni �...c.A SHED_^ r- l p \ . . 2a - a sHEO ^� V. to GIAANE 'D f i CO 1 C.i o sgftu� r u, \ rho - IA C'h • C3 , \ "si 37' 99 fa,N� .�. o . o a A r, -1�" .I _ .�cto g` : , cl S. ti r \ N 4 G ip 9 G s \ `a al ,� N_ t = '3 ,xT w i n, 4, S° 28TOU m ,f -n FRP �i >c - 0 c=+ lad �' A - _ n J—w xa O 1 t.:1 t\)\, • J iIt 1 _ 1 d11 11 p. 1` wpOO FENCE CI " _ - • 1• ; \\ . ., , z. 0.5 't 5.740°9°0 k.a - 1, -.',1'°i, 25) 25) - •2057� Y Jc• Rout ,,-•-„I F Q V _ :74, UNAUTHORQED ALTERATION OR ADDITION TO N.7 4°29° R pA p `I THI SURVEY IS A YKTLATION OF SECTION �i _ _ �� ,• ,.F� 720f OP THE NEIM YORK STATE EDUCATWN IIViCOPIES OF THIS SURVEY MAP NOT SEARING ;,a THE LANG SURVEYOR'S INKED SEAL OR 'SHALL NOT SE ''.J JTo SE VALIDED LTRUE COPY CONSIDERED ft' GUARANTEES INDICATED HEREON SHALL RUN (WO' rn TUF OIT -s^y ....• ,v..!'--.,.•'