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JUDITH T. TERRY ; _ Town Hall, 53095 Main Road
TOWN CLERK -= T • P O. Box 1179
REGISTRAR OF VITAL STATISTICS ;,' 1 Jal ' Southold, New York 11971
MARRIAGE OFFICER / Fax (516) 765-1823
.�. '' _- Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
' SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1614-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New X Existing
Name Of Owner VAN HUELE, BRYAN
Mailing Address 1 214-26 41ST AVENUE
• Mailing Address 2 SUITE 204
City St Zip BAYSIDE NY 11361-2134
Property Address, 1 1500 ALDRICH LANE
Property. Address 2 •
City St Zip LAUREL NY 11948-0000
Owner Telephone No. 718-279-3435
Tax Map No. section 125.00 block 1 lot 2.014
Cross Street FRANKLINVILLE ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 1/17/91 Judith T. Terry
Southold Town Clerk
•
(TOWN SEAL)
•
OFFICE OF THE TOWN CLERK ' PFFD
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Town of Southold � ,. Co Application No./ /
Judith T. Terry, Town 'Clerk . -;4** :• ;.
,,,�� _► ..0 1 $10.00 - Residential) �� )
Town Hall, 53095 Main Road \ ,
" '`"i`• ; i $ Non-Residential
P. O. Box 1179 � 'tip`'" �':�=":�' � 25.00 -
Southold, New York 11971
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
I
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 59-C9
Fee $ /0
DATE Mf d / A°
'OWNER NAME: Bi[ /9-Ai I4 NtLE • •
OWNER MAILING ADDRESS: c2` 7(p '// 40-e- SUM cQ0-1(
1�� 6 icO Al /. /J fr-a i3i/
OWNER PROPERTY ADDRESS:__ 6J00` 9K-#: ,(qY5
OWNER TELEPHONE NUMBER: (-2-7 ' ) 07-79-3 .35
TAX MAP NO. : Section /0/.5. Block I Lot r l 1
CROSS STREET: rinAriN/✓JeALE ROg-p f _
TYPE OF SYSTEM: Septic Tank New Existing
9
Cesspool New )( Existing
Residential I'\ Non-Residential
DATE OF PREVIOUS PUMP-OUT: /4,5W
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.)
274,
Signature of Applicata
RECEIVED BY:
REEMECIerk's Office
DATE: DGp
Trnvri Clerk Southold
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•SURVEY FOR -
BRYAN VAN HUELE a YOLA SZKODZINSKI NOV. 5,1990
LOT NO.5 "LAUREL ESTATES EAST, SECT. I JUN 21,1990
JAN.3,1990
4. AT LAUREL DATE: NOV.7,1989 .
. ;. " TOWN OF SOUTHOLD- SCALE: I"= 50' '
SUFFOLK COUNTY, NEW YORK N0. 89-1251
. *UNAUTHORIZED ALTERATION OR ADDITION TO THIS GUARANT---'-igP. • N b
SURVEY M AVIOLATIONL OF SECTION 7209 OF THE BRYA Er*
;' NEW N COP ESKOFTTHIS SURVEYATE ONOT REARING THE LAND YOL'.SZK►a _I SKIw N LAWj�
, SURVEYOR'S INKED SEAL OR EMBOSSED SEAL"SHALL , CO i ON.'�TH LAID H"I URANCE -
NOT BE CONSIDERED TO BE A VALID TRUE-COPY CO � h ..
*GUARANTEES INDICATED HEREON SHALL RUN ONLY TO �E1
`- • •HEALTH DEPARTMENT'-DATA FOR'APPROVAL TO CONSTRUCT THE PERSON FOR WHOM THE SURVEY IS PREPARED RI. ER.'E•AD : kts4s.,,Al `• SB
_ AND ON HIS BEHALF TO THE TITLE COMPANY,GOVERNit fl-
' N NEAREST WATEN MAIN MI.* *SOURCE OF WATER= PRIWITE_PUBLIC_ MENTAL AGENCY AND LENDING INSTITUTION LISTED , *t
• ' N SUFF CO. TAX MAP DISTTOOO SECTION 125 BLOCK�-LOT 2_14 HEREON,AND TO THE ASSIGNEES OF THE LENDING .^ -_
*THERE ANE 41 DWELLINGS WITHIN 100 FEET OF THIS PROPERTY INSTITUTION. GUARANTEES ARE,,NOT TRANSFERABLE
TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT" . -
OTHER:TNAN THOSE SHOWN HEREON. 40+
OWNERS ': 4 -. . . ,9- i
N,-THEWAT#R SUPPLY AND SEWAGE DISPOSAL SYSTEM FOR THIS RESIDENCE 1/4 .. A,
*DISTANCES SHOWN HEREON FROM PROPERTY LINES - - '
` - ' •OF WILL
COHEANFH SER TO THE
ES. STANDARDS OF THE SUFFOLK COUNTY DEPARTMENT TO EXISTING STRUCTURES ARE FOR -A SPECIFIC `'• • ~�`�+�0• tgND• uR��Q '
APPLICANTS PURPOSE AND ARE NOT TO BE USED TO ESTABLISH -
PROPERTY LINES-OR FOR THE ERECTION'OF FENCES -
AOp1SS` - _-
- • TEL 400 OSTRANDER AVENUE
e YOUNG YOUNG RIVERHEAD, NEW YORK
. NOTE: •IMONUMENT �gSTAKE R
. _ ALDEN W.YOUNG,PROF€SSIONAL ENGINEER
. ` SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERK OF , '
AND LAND SURVEYOR•N.Y.S.UCENSE NO.I2845 -
- • -SUFFOLK COUNTY ON APR.4,1985 AS FILE NO.7870 . '
- -, HOWARD W.YOUNG, LAND SURVEYOR
'- *TIE"LOCATIDIIOFWELL(W),SEPTICTANK(ST)&CESSPOOLS(C*)SNOWN,HEREON • N.Y.S.LICENSE NO.45893• - - • •
`'�'`" APE'PROM-imp OBSEIIATIONS AND OR,DATA OBTAINED FROM OTHERS ' _ - -i=
4BRAS NQS 1-30NS INC. 1046 `__ r. ,