HomeMy WebLinkAboutOlsson, Frederick (2) SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 3518 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : FREDERICK OLSSON
Address 1: 3 GLENWOOD AVENUE
City St Zip HASTINGS-ON-HUDSON NY 10706
Descripton of Proposed Construction or Alteration
REPLACE OLD POOL WITH NEW TYPE (OLD POOL COLLAPSED) .
MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS, BUILDINGS, PROPERTY
LINES AND WATER BODIES. EXCAVATION INSPECTION REQUIRED.
Name Of Owner FREDERICK OLSSON
Mailing Address 1 3 GLENWOOD AVENUE
City St Zip HASTINGS-ON-HUDSON NY 10706
Property Address 1 3280 NASSAU POINT ROAD
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 111.00 block 4 lot 3.020
Cross Street VANSTON ROAD
Building Permit Number Cross Reference:
Issue Date: 4/09/07 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE ,O l0 Town Hall, 53095 Main Road
TOWN CLERK * *; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS vs
Southold, New York 11971
MARRIAGE OFFICER ' G Fax Fax (631) 765-6145
1. •
RECORDS MANAGEMENT OFFICER %` ��0 Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ---�COUNTY,* southoldtown.northfork.net
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
iAl 2r
TO: Southold Town Building Department 5
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: April 5, 2007
Transmitted herewith is a copy of application No. 3676 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Frederick Olsson (work by Peconic Cesspool)
Please review the application and location map and advise if this office may issue the permit.
Please complete the form below and return it to me.
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments: Maintain required setbacks from adjacent wells, buildings, property lines and water
Bodies. EXCAVATION INSPECTION REQUIRED. .
Signature
49 /03.-- -7
Dated
Oil SUFF040
ELIZABETH A.NEVILLE S Town Hall, 53095 Main Road
TOWN CLERK ; P.O. Box 1179
Z ; Southold, New York 11971
REGISTRAR,OF VITAL STATISTICS vy Af
MARRIAGE OFFICER L O .F � Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER v oft Telephone(631) 765-1800
_ � Qi
FREEDOM OF INFORMATION OFFICER = * southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @ $10 /or Non-Residential @$25Application No. (9
Permit No.
Applicant Name f—R b e R\ c n 2- .5 (f)
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Applicant Mailing Address 7 GL- iv kdooro_t 4 c
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Septic Tank or Cesspool
Brief Description of Proposed Construction or Alteration Ace oC-p rPo 0/
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Location of Proposed Construction/Alteration:
Owner of Property: F RFS tto C
Owner Mailing Address: ( GN ° 929 V ,
LAST N (rS- p µ - P 9 fl it( 1 � . /b7 t -4
Owner Property Address: /Yr
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Name and phone number of contact person 1>IC 1 AR G.11- o?gg
Tax Map No: 1/Section // / Block Il Lot 3 0, ACross Street V /4 NI 5 rt
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
Signature of Applicant Date
Received by: J� S�
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