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JUDITH T.TERRY d • Town Hall, 53095 Main Road
TOWN CLERKkx
k , , P.O.Box 1179
REGISTRAR OF VITAL STATISTICS 4$ Southold,New York 11971
MARRIAGE OFFICER ���,, �'=G, ``� i�1
Fax(516)765-1823
RECORDS MANAGEMENT OFFICER � `Ls' 4r.09. Telephone(516)765-1800
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1397 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : JOHN VASSIL
Address 1 : 155 BAYVIEW ROAD
City St Zip MANHASSET NY 11030
Descripton of Proposed Construction or Alteration
REMOVE EXISTING CESSPOOL AND REPLACE WITH NEW POOL IN SAME LOCATION.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION
INSPECTION REQUIRED.
Name Of Owner VASSIL, JOHN
Mailing Address 1 155 BAYVIEW ROAD
City St Zip MANHASSET NY 11030
Property Address 1 495 ROCHELLE PLACE
City St Zip MATTITUCK NY 11952
Tax Map No. section 144.00 block 4 lot 1 .000
Cross Street BAY AVENUE
Building Permit Number Cross Reference:
Issue Date: 10/10/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY o ' 'y`.,'i µ'Town Hall,53095 Main Road
%TOWN CLERK t „s ::' g P.O.Box 1179
REGISTRAR OF VITAL STATISTICS V V 0 Southold,New York 11971
MARRIAGE OFFICER �°j+ •®� I�
Fax(516)765-1823
RECORDS MANAGEMENT OFFICER
Vie s2 l''ta.� Telephone(516)765-1800
FREEDOM OF INFORMATION OFFICER .,`.z,.,,',�tS'
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OFFICE OF THE TOWN CLERK ,
TOWN OF SOUTHOLD RE C''o' 100 !fl I
TO :Southold Town Building Department r
turi
FROM: Linda Cooper, Southold Town Clerk's Office . , 51 R
DATED: October 5, 1995 4` -_'y1. _ �____
Transmitted herewith is a copy of application No. A1450 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
- John, Vassil .
Please review the application and location map and advise if this office may
issue the permit.
Please complete the form below and return it to this office.
Thank you.
Linda J. Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the following recommendation:
APPROVE - 2
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
D / . ,, . - ...-iede...; ..,-....
tactual Signatu
1 1995
OCC - / s----
WOCIQt1�
coo Date
OFFI.r- `VF THE TOWN CLERK ,is"'
Town of Southold /OfOUre,.
Judith T. Terry, Town Clerk �l/y'. Application .�� 5G
Town Hall, `53095 Main Road Construction
Z '
P. 0. Box 1179
Southold, New York 11971 c�t�
Telephone �y0 ��O�i�/ Alteration
$10.00 - Residential
(516) 765-1801 1 * �'� $25.00 - Non-Residential
TOWN OF ,SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION • -
for RECEIVED
CONSTRUCTION or ALTERATION PERMIT OCT " 5 1995)
SEPTIC TANK or CESSPOOL Southold Town Werk
Permit No.
Fee $
DATE
APPLICANT NAME: aohn (.15-5 I
APPLICANT ADDRESS: yg5 �socHF..LL fug
c '
, ri-rocK , k) `/ 11952
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
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LOCATION MAP: Must_ be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: 1.61-ti
OWNER MAILING ADDRESS: 1,5-5- Aovr/1� j it(cp,Z
Mciosi ossz_,, N Y //030
' OWNER PROPERTY ADDRESS: 4/95" Jc/ 72vc -
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Zr- ,v7r,ruck /t"/ //9S&
TELEPHONE NUMBER OF CONTACT PERSON: Z98- 969.3
TAX MAP NO. : Section 1 -1 y Block y Lot I
CROSS STREET: 4,.,y w&
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of Applicant
RECEIVED BY: c 9
own' erk' Office
DATE: M '
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