HomeMy WebLinkAboutMatassa, Vincent (2) •
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ELIZABETH A.NEVILLE / 00 OGyd Town Hall, 53095 Main Road
TOWN CLERK o P.O. Box 1179
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Southold,New York 11971
REGISTRAR OF VITAL STATISTICS rrt t
MARRIAGE OFFICER Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER Fax
a�l��,' 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. 3194 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : VINCENT MATASSA
Address 1: PO BOX 112
City St Zip SAYVILLE NY 11709
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 #R10-04-0013
Name Of Owner MATASSA, VINCENT
Mailing Address 1 PO BOX 112
City St Zip BAYVILLE NY 11709
Property Address 1 850 PRIVATE ROAD #22
City St Zip SOUTHOLD NY 11971
Tax Map No. section 76.00 block 1 lot 15.006
Cross Street MAIN BAYVIEW ROAD
Building Permit Number Cross Reference:
Issue Date: 9/01/04 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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�o�OS11FF0L, .0 11 /
ELIZABETH A.NEVILLE �� � t: Town Hall, 53095 Main Road
TOWN CLERK ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ` Southold, New York 11971
MARRIAGE OFFICER �` 41 )'/ Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER �_ 7�1 *to' Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ���� southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: June 14, 2004
Transmitted herewith is a copy of application No. 3335 for a Cesspool/Septic Tank Construction
Permit submitted by:
Vincent Matassa
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: mor- 14111PP
24:2
Signature
Dated
1 ,////I,,,,
/��,o�OStFFO(,�co
ELIZABETH A.NEVILLE 'I�`1` Gy Town Hall, 53095 Main Road
TOWN CLERKP.O. Box 1179
t c Z Southold,oNew York 11971
REGISTRAR OF VITAL STATISTICS v i
' .F � Fax(631) 765-6145
• MARRIAGE OFFICERRECORDS fit, I. Telephone (631) 765-1800
FREEDOM OF INFORMATION OF ICER - '� * �aO��'' 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 VI Ne.ENT 144-TA.Ss 4
Applicant Mailing Address P 0. Q dX /1z
'Ayvic'e
Septic Tank tc or Cesspool
Brief Description of Proposed Construction or Alteration
e6'J .,vG/y .0/• iLj i)&cGG 'Ar6
Location of Proposed Construction/Alteration:
Owner of Property: 14 c.e ,.i-Ti¢ 3.509.
Owner Mailing Address: P O • 8 0). //.Z
/2Ay✓,LLf ,Vy // 705
Owner Property Address:: V K 11/4re --RI, b
�ou7k a LJ
Name and phone number of contact person Sie, 93 9- 044 l�
Tax Map No: 100° Section l 6 Block 0 / Lot /574
Cross Street //f/9,N Bay 14 E 4-40
NOTE: LOCATION MAP MUST BE SUBMI " ED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY 'I - TH DEP• 'iMENT APPROVAL
2911PAIT-1 he 4v
ignature of Applicant Date
Received by: %� - ;UL-k-'��
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SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
O„� ,�� - PERMIT FOR APPROVAL OF CONSTRUCTION FOR A
6a�� 45°..0\
� �/ SINGLE FAMILY RESIDENCE ONLY
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DATE-1\ F{.� RE4 NO R t U Dy-oor)
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t •\ •\ � .� 44 A 0� \ 4���. APPROVEC Pnv��\/lnvs
\ R •/ �It 1 \ . FOR MAXIMUM OF 4 BEDROOMS
'\1'4\• /� �' , \ f ,, EXPIRES THREE'VEARF FROM DATE OF APPROVAL
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