Building Department
INC. VILLAGE OF CEDARHURST
200 Cedarhurst Ave. Cedarhurst, NY 11516
516.295.5770 | www.cedarhurst.gov
FUEL OIL / GAS TANK INSTALLATION / REMOVAL / ABANDONMENT PERMIT APPLICATION
Date: Application/Permit #: Fee: $
Owner/Applicant Name:
Address: Telephone #:
Address where tank is located:
Section: Block: Lot(s): Zone:
Size of Lot: Residence: Commercial:
Type of Tank: Fiberglass Steel Gallons:
Above Below Ground Depth Underground:
Diagram of location of tank:
Contractor’s Name:
Address: Telephone # :
Date tank to be removed / installed or abandoned:
In consideration of the granting of the permit for the installation, removal or abandonment of a fuel oil
tank or commercial gasoline tank, the applicant agrees to comply with all provisions of Article XI of the
Nassau County Public Health Ordinance, Section 3.6 of the Nassau County Fire Prevention Ordinance,
all regulations of the Environmental Protection Agency and the Code of the Village of Cedarhurst and
NYS Fuel Gas Codes.
Applicant’s Signature:
Sworn to before me this day of , 20 .
Notary Pubic, Nassau County, New York
click to sign
signature
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