HomeMy WebLinkAboutMattessich SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4366-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner ANTHONY MATTESSICH
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Mailing Address 1 7 SUTPHIN ROAD
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Mailing Address 2
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City St Zip FLOMINGTON NJ 08822-3153
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Property Address 1 290 TOWN HARBOR LANE
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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. 908-313-0657
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Tax Map No. section 62.00 block 3 lot 3.900
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Cross Street MAIN STREET
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Issue Date: 12/13/07 Elizabeth A. Neville
-------- Southold Town Clerk
(TOWN SEAL)
r �
ELIZABETH A.NEVIIdZ Town Hall,58096 Main Road
TODWN CLZRK P.O.Boat 1179
Soathold,New York 11971
REL IBTBAR OF VITAL BTATV1'1'IC8 Am(681)76116
�ZOMCXR 68Telephone(881)7'861800
RECORDS OFFICBB
FREEDOM OF WMRMATION OFFICER aouthalkitown northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
OPERATION PERMIT
CESSPOOL or SEPTIC TANK '
Residential @$10 or Non-Residential @$25 Application No.H3 b `'
Permitbio �
Owner Name Ao /c 11
Owner Mailing Address �l Su►pN 1 14 20
o & s OR- n).r2
Owner Property Address o� y l��/�S ffia
tzvku Lo
Owner Telephone No. e?0 t— 3 t 3—v(O S --7
Tax Map No: /W'Z Section do Block 3 Lot
Cross Street MA►!J rl .
Please check each that applies: New Codon x
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.)
Si f licant Date
Received by: �
SURYEY OF PROPERTY
SITUATE: SOUTHOLD N
TOWN: SOUTHOLD
SUFFOLK COUNTY, NY W E
SURVEYED 08-24-04 _
REVISED 07-18-2006 S ;
FOUNDATION LOCATION 08-24-2006
FINAL SURVEY 10-26-2007
SUFFOLK COUNTY TAX #
1000-62-3-3q "
SUFFOLK COUNTY DEPT. OF HEALTH
5ERVIGE5 REF. # RIO - 04 - 0160 - �
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AREA = 22,827 5F or 0.53 Acres JOHN C. EHLERS LAND SURVEYOR
GRAPHIG 5GALE 1"— 30' 6 EAST MAIN STREET N.Y.S.LIC.NO.50202
RIVERHEAD,N.Y. 11901
369-8288 Fax 369-8287 REF.-\\Compagserver\pros\04\04-261.pro