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JUDITH T.TERRY ��� ?'1: Town Hall, 53095 Main Road
TOWN CLERK % P.O. Box 1179
�� Southold,New York 11971
REGISTRAR OF VITAL STATISTICS `®* ,��� Fax(516) 765-1823
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER � 6." 41 4:010 Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER ,g"
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3529-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner OLSSON, FREDERICK
Mailing Address 1 3 GLENWOOD AVENUE
Mailing Address 2
City St Zip HASTINGS-ON-HUDSON NY 10706-0000
Property Address 1 3280 NASSAU POINT ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 000-000-0000
Tax Map No. section 111 .00 block 4 lot 30.002
Cross Street OLD MENHADEN ROAD
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Issue Date: 10/18/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
i''JFFICE OF THE TOWN CLERK COMA'
Town Town of Southold �� CSG Application No.&5 Z7
Judith T. Terry, Town Clerk �� �r 't� tx --61)
4xt,
Town Hall, 53095 Main Road �i :'G $10.00 - Residential,_
P. O. Box 1179 w � �=,'{ w ► Z` $25.00 - Non-Residential
Southold, New York 11971
Telephone
."'01 �
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE / Z0 / q9
OWNER NAME: O —,\C v� aL5D' \
OWNER MAILING ADDRESS: 3 r�f/-/ WDD7412f QST/A165 -
OWNER PROPERTY ADDRESS : 1.� /-trt � r2 -_�-__-�--
OWNER TELEPHONE NUMBER:
TAX MAP NO. : Section 1 f I Block -! Lot 30:Z.--
CROSS STREET: off 5$,4 - 1 1% d2-0M (
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
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.)
Signature of Applicant
��` \RECEIVED BY:
Town CI r 's Office
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CERTIFIED TO SURVEY OF
,AND SII Prepared in accordance with the minimum TI COR TITLE GUARANTEE y
Gj�o t. METS '91- standards for title surveys as established by BAY SIDE FEDERAL SAVINGS 8 LOAN ASSOC P/O L 0 T 17 0 „.
U� '0 C�9 to, the L.I.A.L.S. and approved and adopted FREDERICK O L SS EN / FX
,. 11 for such use by The New York State Land AMENDED
MENDED MAP A OF NASSAU POINT ..4
zi . 1MURIEL OLSSENteAssociation. FILED AUG. 22, 1922 tAP NO. 156
flitt
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��-11dif%,.. ct496 _,A AT NASSAU POINT
OF NE N.YS. LIC NO. 49618 AREA = 28, 823 SQ FT. TOWN OF SOUTHOLD
TO CHORD SUFFOLK COUNTY, N. Y.
PECOII,IC SURVEYORS a ENGINEERS, P. C. 1000 - 111- 04 — 30
(516) 765- 5020 SCALE 1 �� = 40
P.O. BOX 909
MAIN ROADJULY ll, 1986
SOUTHOLD, N.Y. 11971