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HomeMy WebLinkAboutOlsen, Leo �° ��S�fF0��00 O p � , ELIZABETH A.NEVILLE off Town Hall, 53095 Main Road TOWN CLERK y 2 P.O. Box 1179 O *' t Southold, New York 11971 REGISTRAR OF VITAL STATISTICS � y 0' � Fax (516) 765-1823 MARRIAGE OFFICER - %°9°.°0 Telephone(516) 765-1800 RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER ""' 0��� OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 1924 R Residential X Non-Residential Fee $ 10.00 Septic X Cesspool PERMIT ISSUED TO: Name : LEO OLSEN Address 1 : 211 SACKVILLE ROAD City St Zip GARDEN CITY NY 11530 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 #R10-98-44 Name Of Owner OLSEN, LEO AND GERALDINE Mailing Address 1 211 SACKVILLE ROAD City St Zip GARDEN CITY NY 11530 Property Address 1 3590 MAIN ROAD City St Zip GREENPORT NY 11944 Tax Map No. section 35.00 block 3 lot 28.012 Cross Street GULL POND LANE Building Permit Number Cross Reference: Issue Date: 9/10/98 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) FOL � ,�c ELIZABETH A.NEVILLE `1 �*. 1 Town Hall, 53095 Main Road TOWN CLERK p P.O. Box 1179 y Z Southold, New York 11971 REGISTRAR OF VITAL STATISTICS O �� Fax (516) 765-1823 MARRIAGE OFFICER y O�,�� Telephone(516) 765-1800 RECORDS MANAGEMENT OFFICER Biel � al FREEDOM OF INFORMATION OFFICER 10°- OFFICE OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TO: Southold Town Building Department FROM: Linda J. Cooper, Southold Town Clerk's Office DATED: August 28, 1998 Transmitted herewith is a copy of application No. 2001 for a Cesspool/ Septic Tank Construction Permit submitted by: Leo and Geraldine 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 recommendations: APPROVE DISAPPROVE Comments: ;ignatu e 9/1/ /x- Dated • ii'''• .OFFICE OF THE TOWN CLERK Town of Southold � Dt.& Application No. a0(j I Judith T. Terry, Town Clerk h Town Hall, 53095 Main Road c Construction ✓ P. O. Box 1179 Southold, New York 11971 ��i • Alteration Telephone '0l • `� Residential✓ (516) 765-1801 - Non-Residential TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for CONSTRUCTION or ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. Fee $ DATE 64/4:,)e/9, APPLICANT NAME: Leo 9A'.c2A) APPLICANT ADDRESS: Q I l SAc% U`Ue )2a0 6A-40eAi SEPT I CX CESSPOOL DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION E 3 ®°e e LOCATION MAP: Must be attached hereto before permit may be issued. LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: OWNER OF PROPERTY: Lees -1 c ' 44 e ©)sem OWNER MAILING ADDRESS: 021 f S Cfi/ 44e ,qC�/.�, jP,t.) Cilc y //d'3C$ OWNER PROPERTY ADDRESS: 3, !�q U /144/A.),0 (oc �i97 ' .`OAR.e r Pl? _ TELEPHONE NUMBER OF CONTACT PERSON: Sl� 73/ /73 3 1.7 /1/1- TAX FTAX MAP NO. : Section Block 3 Lot a w . CROSS STREET: GULL- rOX)0 BUILDING PERMIT NUMBER CROSS REFERENCE:.. Signature of Applicant RECEIVED BY: C RECEip Clerk's Office DATE: AUG 2 3 1998 Southold Town Clerk ,i/oz m' ,r ?o 447 ,e 2 5 Qti!-c Dem tAi �To W4TilQ.i14444 Sc NA - i L urrtna br7, LG�crsT1,v4) ie: l O / ,n`.:1. w4TbL OE7e_is •T ��i s < L sztalp /4-t ) i4s-to-1 NI - 1 1f/ ® / . ) � ek „_ -P. f , Q►- • Io i`I �,� y �r.>.J 1�u� ' EXCAV TION IN: x cr_ iV I '©R S•NS•, I: I i B' ; g \ HEA TI- ' F t' 9 310 ••"/ I • r c' ro I I n194 *06 1 / � 9 r c 17 LoT I2LA 1J . PiNgrg it'. ti- - A V tt(s . _ . 4. r ' , ) S' (.640 I K;419' ` 4. •••••• „ . '�� � TA,K M►1-O 0411 Pt ISge-•- 100o -35-3- 2.Q � ;z�.t f Sfl!'^— ( • \ a Frk a-r-�u:.) CI r- •ems q G� Y �.CAA T CJ L' Ce .VT11=(h, (' b�JlG,-f le`-” • fit--' I Itf'" TO • ghteFILL )/14 Areao ✓/kl_ at= S ec..J-w G K Sf Srus n 4-.- S-.?,sr-p-- • CAiII.`Q5 num%ill �._ . ccra�g . 4" P1Pf cc ;�' ,�.•, ,,., , a,-cam .5 +9.c --* L 4,. t.Lio.° - lxiv da iNv 4•6 . pi , • SEWF2 rr Jc. 5.i '.-9 i , -1-.i puoPIN f.A N - Z -V • 4- 3 0'0" x 2„0 6'1"X tyQM to W 6a.. , LEACNIN pc, i.�: $aP7I 1A 1L �4 0 ✓ej� ; Anel /%O. ig �'r"tG7 ! ", 'a• •. � . ii r1r,'1A SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES I D R CONSTRUCTION ONLY H.S.REF.NO. (LAPPROVEo-FO - u FLOW f (bRN ?7c 25 ThisTYPEag for the construction of the sanitary disposal and water supply farcies pursuant to/tittles VB and vv«tc e 114444 SC-VIA - A 7 d the Suffolk County Sanitary Code and is not an expressed s-F1Nb> nor kupled approval to discharge from or occupy the shucture(s) shown. THIS,APPROVAL )t• 1: 8 THREE (3) .. YEARS FROM THEt3EL0w. illter.4404.,....a. ,_._ — ... - JUN_ 0 8 199 •'k DATE SIGNATURE !} S-Et°-98-cia4� _- .4Q 78.G, a.1 girir + —� O .o -77-7-1" V in B1s74.4 1ZE5, ►lss- SNowww TCIt.G7 , `' - .. l s UZFAEE F41.44nirS f ice -' MtXED SAt4D aLoA/A �I P K r�i�/t D ;' EXCAN, ',....f.'4' EXCAVATION INSPECTION REQUIRED • 1 FOR SANITARY SYSTEM 1424'.C71. 1 BY HEALEPARTMENT `:i Illr---- '&tISTtl,L6� WK.o fr+ \ fie°WN CLAY w io' se u.e: Az d o• c.9 n -Jl+�' F4 L�ii► $lG4 WAiFINE 10CA41tfs l 3l►►J D o WATCR. lrJ PALE. wow*, FtNP To cackesa 5 Ate/O Er i ..... kk rr 't WATER. GmGOU/JTEOVO 8.4' 8%L0t4 SUR # �� -�,'yii' (S 4 - 15' TEST 4QLE 6Y mC9ONALS2 i111714i,4IGY` 2-12,4,6 ....__w_ . J.,. •.12. TE 5T HOLtc DATA �. - `Th I`►-w �c • ggceFtU. 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