HomeMy WebLinkAboutMattina SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4417-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner CHARLES MATTINA
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Mailing Address 1 65 OLD FARM ROAD n
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Mailing Address 2
City St Zip LEVITTOWN NY 11971-0000 \�
Property Address 1 545 KOKE DRIVE '
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Property Address 2
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City St Zip SOUTHOLD NY 11971-0000
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Owner Telephone No. 516-906-1726
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Tax Map No. section 87.00 block 5 lot 14.000
Cross Street MAIN BAYVIEW ROAD
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Issue Date: 6/07/10 Elizabeth A. Neville
-------- Southold Town Clerk
(TOWN SEAL)
o�osuFFot,��o
ELIZABETH A.NEVILLE o� Gy Town Hall,53095 Main Road
TOWN CLERK coo Z P.O.Box 1179
REGISTRAR,OF VITAL STATISTICS O Southold,New York 11971
.
RECORDS
MANAGEMENT OFFICER RIAGE.OFFICERy��• aO�� � -� Telephone�(631) 765=,6145
�► (631)'765-1800
FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net
'RE-CEMD
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
JUN 4 ZOIO
SOUTHOLD WASTEWATER DISTRICT
APPLICATION Southold Iown Crlerk
_ OPERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @$10 or Non-Residential @$25 Application'No. c/
Permit No.
Owner Name Cf/ALt4 ;J A4A?7'1,-)A
Owner Mailing Address /ems 61-o /jo, m
Owner Property Address .40x&
-
Owner Telephone No. S!G -40(0 —r 7 ZC.,
Tax Map No: /&50 Section 8'7 Block Lot /
Cross Street MAID &kJUI , le":110
Please check each that applies:, New Construction _
Alteration to Existing System
Residential Non-Residential
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. (Locate
building and system; give north arrow and approximate distance in feet from system to building
and closest road. New construction may submit copy of survey with SCHD approval.)
Signa "Acant' 15ate
Received by:
post
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TEST HOLE DATA
BY McDONALD GEOSCIENCE
OCTOBER 14, 2008 " °
EL 19.0'
DARK BROWN L 0,4 S! OL
BROWN SILTY SAND Su
EL 2.9' ------ 16.1'
WATER/N PALE BROWN SKTY SAND SN
WA7ER/N BROWN CLAYEY SAND SC
------ 28'
WATER IN PALE BROWN RNE SAND SP
34'
OF
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70N TO THIS SURVEY IS A WOLA77ON .-^ NO. 49618
IEW YORK STATE EDUCA770N LAW. CONICS
7209—SUBDIVISION 2. ALL CER77FICA770NS (631) 765-5020 FAX (631) 765-1797
SIS MAP AND COPIES 7HEREOr ONLY IF =Jt90PJU�;FPJT P.O. 30.Y 909
? THE IMPRESSED SEAL OF THE SURVEYOR
S HEREON. • =PIPE 1230 TRAVELER STREET � y t 413 T p
' A —STIKF SOWHOLD, N. Y. 11971 07-190 7
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SCALE: 1'=30'
SEI'I-EMBER 16, 20(
OCTOBER 16, 2008 (B.(
NOVEMBER 6, 2008 (TC
MARCH 30, 2009 (BOH
'I APRIL 28. 2009 (REVS
AUGUST 29, 2009 (REI
NOVEMBER 6, 2009 (W
JANUARY 20, 2010 (UP
APRIL 7, 2010 (FINAL)
APRIL 0 (REIISIC
MAY 7,20101(REVISION-
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