HomeMy WebLinkAboutOlsen (2) 1,/A))wVFFOt,rco .
ELIZABETH A.NEVILLE ���O 'y ; Town Hall, 53095 Main Road
TOWN CLERK o - P.O. Box 1179
REGISTRAR OF VITAL STATISTICS
W Southold, New York 11971
MARRIAGE OFFICER : �i ' Fax Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER "'/Ql $ ,i' Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER to southoldtown.northfork.net
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OFFICETTOF TTFHSEppTOWN
LDCLERK
SOUTHOLD WAOWATERU DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2912 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : PECONIC CESSPOOL
Address 1 : PO BOX 972
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
ADDITION TO EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES.
EXCAVATION INSPECTION REQUIRED.
Name Of Owner OLSEN, GARY
Mailing Address 1 PO BOX 158
City St Zip LAUREL NY 11948
Property Address 1 6645 PECONIC BAY BLVD
City St Zip LAUREL NY 11948
Tax Map No. section 126.00 block 10 lot 20.000
Cross Street BRAY AVENUE
Building Permit Number Cross Reference:
Issue Date: 10/30/02 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE l i% V Town Hall, 53095 Main Road
TOWN CLERK ; y - , P.O. Box 1179
REGISTRAR OF VITAL STATISTICS % u i Southold, New York 11971
MARRIAGE OFFICER `��,fiiL ����0 Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER "'/Q! . ',,• Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER 'W ,.�� southoldtown.northfork.net
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OFFICE
ing OF THEment TOWN CLERK
1.1U1` OCT - 1 2002 }11:� , TOWN OF SOUTHOLD
•
tTO:rov��: ,Soull'�o� Depart
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: October 4, 2002
Transmitted herewith is a copy of application No. 3029 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Peconic Cesspool for Greg 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.
* * * * * * * * * * * *
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. .
121"9- ,E7g:A
Signature
/4"/) 7/i 2_
Dated
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OFFICE OF THE TOWN CLERK �Ii'COL/(4
TOWN OFSOVIHOLD ,�' JJOQG=
Application No.30t p
ELIZABETH A.NEVILLE,TOWN CLERK
P.O.BOX 1179 y� Construction '
SOUTHOLD,NEW YORK 11971 aC
Alteration
Telephone ,y fz,4r1 ' $10.00 - esidential' - 1 L.,/(63't) 765-1800 '=��1' '�
,r� $25.00 - Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. "
- -Fee $ - -
DATE /Oh 3 P NAME: PECONIC CESSPOOL
APPLICANT ADDRESS: P. O. BOX 972
MATTITUCK, NEW YORK 11952•
SEPTIC CESSPOOL P/
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION '
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: •
. OWNER OF PROPERTY: a 'i 7 0/5 8-
OWNER MAILING ADDRESS: es, A.,,./ 9s-" 9 4f�
OWNER PROPERTY ADDRESS: lo�C I �C1
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section /1-C Block /0 Lot' 20
C-R0:4 STREET: aip—t- e
BUILDING PERMIT NUMBER CROSS REFERENCE: _
•
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App
Signature of cant ' _ "
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RECEIVED BY:
Town Cler 's Office
DATE: ID O �---
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GREG OLSEN
6645 PECONIC BAY BOULEVARD , _v
LAUREL _ - — — -�
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