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HomeMy WebLinkAboutGerry JUDITH T. TERRY , Town Hall, 53095 Main Road TOWN CLERK '7:7.'t_ 3 P.O. Box 1179 REGISTRAR OF VITAL STATISTICS } P j Southold, New York 11971 MARRIAGE OFFICER z� � s �'• Fax (516) 765-1823 +,' Telephone (516) 765-1801 a ' ; � OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 1584-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner GERRY, OTTO F. AND ADELINA M. Mailing Address 1 3716 NW 23RD PLACE Mailing Address 2 City St Zip GAINESVILLE FL 32605-0000 Property Address 1 RAMBLER ROAD Property Address 2 City St Zip SOUTHOLD NY 11971-0000 Owner Telephone No. 904-371-2761 Tax Map No. section 88.00 block 5 lot 43.000 Cross Street PLEASANT PLACE Date Of Last Pump Out 0/00/00 Issue Date: 1/17/91 Judith T. Terry Southold Town Clerk (TOWN SEAL) I. . OFFICE OF THE TOWN CLERK c�vFF�(,(r�'- Town of Southold CSG Application No. /13y Judith T. Terry, Town Clerk . =i` w,:{ - �G 1 $10.00 Residential Town Hall, 53095 Main Road P. O. Box 1179 cn $25.00 - Non-Residential Southold, New York 11971O ®3+ • $ Telephone .OI . Y►�� ' (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for . - OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ DATE ii1 i OWNER NAME: f)c--t'�o r d- A1EL -E&IQir- • OWNER MAILING ADDRESS: 3714 it 23 ?L,. G 1Jf!'✓ILL6--- / FL. a 7,6 d 6� OWNER PROPERTY ADDRESS: I. 3L64-• R, -dLb 1 /41. w, OWNER TELEPHONE NUMBER: q 61 f_ 371 2:74 / 'e'--1-y TAX MAP NO. : Section (5-1-rr Block Lot 4-'3 :- CROSS CROSS STREET: TYPE OF-SYSTEM: Septic Tank New Existing • Cesspool New Existing Residential Non-Residential DATE OF PREVIOUS PUMP-OUT: �I8 PKgVlovl 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.) 4‘)' ' Sign• re of Applican RECEIVED- BY: . -Town Clerk's Office DATE: ,-,-. - , A , - ----j Q ' / ,2.., . A / , A/it 7.! e4- 4.,`id ' . . I LoT 1 - —....... / / / 1.4)l ,, . .-.. . P If) 11 Yt. , 8-1' 2.4:- •40° E I 54-.34 i 01' \ ., 8?-1 .. ..‘„.,„„,.-.....-%Woad 17.a1( Fence i• - ____ - -L.._.____ _ ___. -• '))° 71°1 ..0 II / • .98.S' , , \ , - .. . , 1'4 ii, \ \ • 1,, LI' . ., ' .• • 4- \k ,- * . •. . • ._ _ _ _ ti 1 - S ,. ,... O , \ ' P0le t,t4&ilkt,1 _i) \ , ,,, -,,- . t,-. . L.. .. 4• t‘. ao 3 r, , .. .., .,, u .0 , ,,, I el'- \ • k s. 0 . l - 10' Gi. ..-------- \ e• , 1 , . IA f 4 1 3?. e , \ 1 -. ,Q. r. •c. \-- \ , . Afi.4. - \-- , ,.e • X 1 nr . *. • 13 goo \ 0 '‘ \ % ....... a. N.,• ...001 ‘ ........... . % r. • ...- \ Lille. . . . li (.), "-‘ ‘ k 4 * \ . . • ..rv- \'ii31 I \1.1 • ‘11 - \ q 1.-o T 1 0 . 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"g976:. 40, e D, rot - .-__-4.eumwrreeti To:,Airesiviecarigki.s. - JEROME D'AMARO _.44/..c..e-, X5.11Z.,41Ce..4"--- - ' , . ',•:.S..,;11.7441X1.111101000412442Sibliglaagiffla.4114.541C... .: :•:- .- . . - `' --.W - -, iiiiir • r=34gBae -: ,•,.... ........ ...t...____________________________________ PROFESSIONAL ENG. EER&LAND SURVEYOR OFIL/W.4" ;Cifair., -':.4, SITUATED AT:1211114:110WEltit.7--Wz• si:‘,zsittahrtilttt-13.. t.i#V131..-A*C-:Coo. —'''' ' ' t- _----- . .. .-• 1421EDEERfilARK AVENUE 7.1 D'r,, - .:- ' I te 1 - ....- - I'I'4401411441ASYZON,44:V. -111a3 ,0 , • --oh-. , - . _ • _ , . -, • . .. •'--,7 ;-;".-'-ii b1RAWNir BY '''..'"---".!:'.. ..' . , .AN-IECKED!BY:— -.../..n.. :-/S181/4014i0V167444t3 '.'i seaveimuckaarirrieSVG - 14,1-0 crEtl-'-' noo 4) ; 1 . , ttP,9, l'eL. sv-31-1" s•-•*. ' . ...Unauthorized alterations.or additiortigabir0survey is eviolatiomotsection-72013_of:the New Y'isrlaintte Eduostion•Law. Copies.of this suniey,thap ip•t bearing theitandsuryeyor's Inked-seatectstnbossed•seal shah - - ' %a ctit II' hereon shall,run.onlit to the person,fortoet thesuryey is prepared;eixi Coins behalf to•the title _ ,-gotietiXnentel agency and lending institution tistedtlefelPh,end to the' assignees of the lending.instoution"a"cicsIdenlittn.-Guarantees•or" --tserttft-t"eissetortsarern'oluarli"otransfercibletees"4:137tinktomdditiottecati°7nstitutindicatedions -./ ENgig.. . . , br subsequent owners.7 Offsets are rint.to tie:Hied-to estebtlitt.prow:it/A*, ___._,,€.4 ..4e..7-04'..`-',fgleg,07.7,-.41:51..--" Aw . 40.44).R. - •44ev-'"r• 3'/4*".s.":4-'' ' ' - , i -!:,_-,:,-:'4:_,-,..;,•?_,.',':,-.'...,-;,-.:,...-:-'',-,':•r--,1_...f,'..:Li„4-:::','-c---5,V-,',:...;,,,:- Iv"-,- -,'',714)-;'ii::',-i,-'i,-:,e,n:'t,-,,;'' „,,, ', . 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