HomeMy WebLinkAboutMatassa, Vincent ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF II~O~TIOIXl OFFICER
~{.~gwn Hail, 53095 Main Road
· ~ ' P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO:
FROM:
DATED: Jmae 14, 2004
Transmitted herewith is a copy of application No.
Permit submitted by:
Vincent Matassa
Southold Town Building Deparm~ent '
Linda J. Cooper, Southold Town Clerk's Office
3335 for a Cesspool/Septic Tank Construction
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.
Linda J. Cooper
I have reviewed the application and lo/cation map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments: ~
Signature
~ EL~i~Z.,ABETH A. NEVILLE
TOWN CLERK
REGISTtLkR OF V~TAL STATISTICS
· MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (~ 7.6~-6145. . .
Telephone (631) 765-1800
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 X or Non-Residential ~ $25 __
Application No. __
Permit No.
Applicant Name ~/t
Applicant Mailing Address ~.0. ~vz:
/v:.ff. 117a
Septic Ta~ ~ or Cesspool
Brief Description of Proposed Construction or Alteration
/
~cation of Proposed Cons~ctio~Alteration:
O~er of Prope~: ~ ~W ~ ~
- O~erMall~gAddress: ~ ~' ~ //~
O~er Prope~ Ad.ess: ~1 ~F~
Nme ~d phone nmber of contact person ~/& ~ ~- Cg~ ¢
Tax MapNo:l~O° Section ~ Block ~ I Lot /~
CrossS eet
NOTE: LOCATION ~AP MUST BE S~I~ED ~TH APPLICATION. NEW
~a~re of Applicant Date
Received by: ' ~ ' ~ /
FOR MAXIMUM OF
EXPIRESTHRE~ Y~AR~ FRO~t [