HomeMy WebLinkAboutMessina, Donna (2) I� iii 000L,'
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ELIZABETH A. NEVILLE �= Gy�: Town Hall, 53095 Main Road
TOWN CLERK ; H Z ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER / Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER \__ $a .,i� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ,���� southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 3148 R Residential x Non-Residential
Pee $ 10.00 Septic x Cesspool
PERMIT ISSUED TO:
Name : DONNA MESSINA
Address 1: PO BOX 730
City St Zip CUTCHOGUE NY 11935
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR ONE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. REF #R10-03-0084
Name Of Owner MESSINA, DONNA
Mailing Address 1 PO BOX 730
City St Zip CUTCHOGUE NY 11935
Property Address 1 1470 MANOR HILL LANE
City St Zip MATTITUCK NY 11952
Tax Map No. section 108.00 block 3 lot 8.006
Cross Street MAIN ROAD
Building Permit Number Cross Reference:
Issue Date: 4/15/04 Elizabeth A. Neville
southold Town clerk
(TOWN SEAL)
-111111114
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ELIZABETH A.NEVILLE ��or h GTi; Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
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REGISTRAR OF VITAL STATISTICS V Southold, New York 11971
MARRIAGE OFFICER `� ,j► l �1 Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER =_'�10,( �� ���� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER _ ,�s� southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
X02
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: March 10, 2004
Transmitted herewith is a copy of application No. 3287 for a Cesspool/Septic Tank Construction
Permit submitted by:
Donna Messina
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 location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments:
Signature
Dated
T ,...,,.
,/0,oOSUffO�/�co
ELIZABETH A. NEVILLE O�`t` Gy Town Hall, 53095 Main Road
TOWN CLERK A P.O. Box 1179
ti Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS �y t
O .F % Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER
MARRIAGE OFFICER :`Ifi O�1'�s Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER :0' * asoutholdtown.northfork.net
OFFICE OF THE TOWN CLERK •
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @ $10 for Non-Residential @ $25 Application No. 3-7-51)7
Permit No.
Applicant Namepp 1j 1t) 1\4•e'SS ( i j a
Applicant Mailing Address'( 73
Cv -- o— N`-'( ( 1 ?<
Tank��Ennor ess
Septic x ool p
Brief Description of Proposed Construction or Alteration
Location of Proposed Construction/Alteration:
Owner of Property:T &)&) , . OVA.
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Owner Mailing Address: 'O®1( 7 —
CLA-2J eguQ t (9 3
Owner Property Address: It'll d bl4&1/4_)0K._ 4/1-L L4
r9sZNNA-r--rt -r-0 61C 111S-7--
Name
ame and phone number of contact person
Tax Map No: Section 10 g Block 43 Lot Sr. Yp
Cross Street 1 A l N 7-1:0
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SUR ' WITH HEALTH DEPARTMENT APPROVAL
_ A AAA 11 .
Signature of Applicant r a -
Received by: 1 :�
SURVEY OF PROPERTY
5IMATE: MATT ITUCK N
TOWN: SOUTHOLDw E
SUFFOLK COUNTY, NY
LOT NUMBERS SHOWN HEREON S
REFER TO MINOR SUBDIVISION
MAP OF "TOT'S ACRES"
SURVEYED 01-14-03
SUFFOLK COUNTY TAX u
1000-IO8-3-8b
CERTIFIED TO:
10
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(J3 111°3 j r fS 6 EAST MAIN STREET N.Y.S.LIC.NO.50202
GRAPHIC SCALE I = '•f00 RIVERHEAD,N.Y. 11901
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