HomeMy WebLinkAboutOlsen, Robert _ow iii
OFFO4COG.
JUDITH T.TERRY te.1 Town Hall, 53095 Main Road
TOWN CLERK ; y P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Q Southold, New York 11971
MARRIAGE OFFICER �y� c •i Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER ,( * *Vile Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER �
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1789 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : MICHAEL PISACANO
Address 1 : P. O. BOX 1931
City St Zip SOUTHOLD NY 11971
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. REF #R10-97-0176
Name Of Owner OLSEN, ROBERT
Mailing Address 1 70 CHERRY LANE
City St Zip SMITHTOWN NY 11787
Property Address 1 LEEWARD DRIVE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 79.00 block 7 lot 25.000
Cross Street JACOB LANE
Building Permit Number Cross Reference:
Issue Date: 12/31/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
co��,���strFO(,, ; /
JUDITH T.TERRY ~ ' l5 i r---77777.-------117'70 53095 Main Road
TOWN CLERK ; y . Box 1179
Sout 4; New York 11971
REGISTRAR OF VITAL STATISTICSOy �. 0 1997 F' (p16) 765-1823
MARRIAGE OFFICER O•��
RECORDS MANAGEMENT OFFICER %%701 ����� TeIPioe(516) 765-1800
FREEDOM OF INFORMATION OFFICER , s'
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: December 30, 1997
Transmitted herewith is a copy of application No. 1863 for a Cesspool/
Septic Tank Construction Permit submitted by:
Michael Pisacano for Robert Olsen
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.
Thank you.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following rec mendations:
APPROVE
DISAPPROVE
Comments:
Signature
12l 3o
Dated
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O|'/�|(�L-OE THE lOWN CLERK
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- town o oo � � /\|�|J|caU*', Hu'«�
/.uU||/ T. Torry. Tow" clerkclerk '' '(?3
l\`wo Hall, 53095 Main Road
Construction._16_- .
Y. U' Box � ���
Alteration
Soo||x/|J' New York 11871 ---- - -•� Residential )(rTe|ephuoe ' -�-^~-'--'
(516) 765- 1001 -^«r'/''^� NonResidential_ _ _..
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TOWN OF S0UT||oLU
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S(]UT||0]) VV/\Sl•EYV/\TBl DISPOSAL D|DTR |CT
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CONSTRUCTION or /\!]F|](AT|0N PERMIT
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• SEPTIC TANK or CES0`001.
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Permit No.
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F.,, $
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DATE 42-,-.5"0 "--
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APPLICANT NAME: �J
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N`|1 |(��N[ ADDRESS: �� �301� / u��� >
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SEPTIC CESSPOOL "t.` `
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U[SCR||'T|0N OF PROPOSED CONSTRUCTION OR /\L[ER/\TftJN
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LUCm.k)N MAP: Must be attached hereto before permit may be Issued.
LOCA.!.ION OF PROPOSED CONSTRUCT ION OR ALTERATION:
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OWNER OF PROPERTY : 4--S"E4d /
OWNER MAILING -7g
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OWNER PROPERTY ADDRESS:
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TELEPHONE NUMBER OF [oNTxCl• P[RS0N : �� �� +-
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BUILDING PERMIT NiVWDBR CROSS REFERENCE: ':-`---- ---------- -' ---` -'
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to this survey Is•*ldonof
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