HomeMy WebLinkAboutPugliese, Ralph Jr ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF \qTAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFOR3,C. kT[O~0~N ~.L~ CER
T( ~?~! Southo'~tilding Depamnent
FROM: Linda J. Cooper, Southold Iown Clerk's Office
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (6311 765-6145
Telephone (631) 765-1800
southoldtown.nort h fork.net
DATED: Ma3, 6, 2005
Transmitted herewith is a cop.,,' of application No. 3465
Permit subnfitted by:
for a Cesspool/Septic Tank Construction
Ralph Pugliese Jr.
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 fonn below and return it to me.
Linda J. Cooper
I have reviex~ ed the application and location map of the project cited above and make the following
recommendations:
APPROVE ~
DISAPPROVE
Comnlents:
Signature
Dated
ELIZABETH A. NEVILLE "
TOWN CLERK
REGISTRAR OF VITAL S'gATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICEE
FREEDOM OF INFORMATION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 1197~
Fax (631) 765-6145
Telephone (631) 765-1800
sour holdtown.nort hfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential ~ $10 / or Non-Residential ~ $25 __
Application No. ~q
Permit No.
Location of Proposed Construction/Alteration:
Owner Property Address:
Name and phone number of contact person
Tax Map No: Secfion~ C~
Cross Street
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVF~ WITH HEALTH DflTxPARTMENT APPROVAL
5UR-.~ OF LOT ~ .2 --
SURVEYED: 0-~-01-01
PF'.OPOSEIP HOUSE 0-~-2~-04
SUFFOLK COUN'FT' TAX ~
IOiOO-q'~ -4-1-/.2
t
~OUN??,j~... -c...,:..:, ~P ~E~LFH SERVICES
P~MIT FOR APPRovA~ OF CON--RUCTiON FOR A
SINGLE ~ANIL~ ~ESIDENCE ONLY
-- ~. ,)A~. of APPROVAL
Ldo # *~
Lo~ # Z
N
w -'~ E
S
NOTES:
· IciONUf'4ENT
0 PIPE
· SPIKE SET
FLEVATIONS REFERENCE COUNTT' TOPO HAPS
'TOTAL AREA = ~O,O~,~a S.F.
..'~EA EXC. R.OJ/',I.= ~,O, IO2
®RAPHIC, .SCALE I"=
TEST HOLE
FROH
FILEP HAP
TOPSOIL
HHITE COARSE
SAN~
YELLOH COARSE
SANO
JOHN C. EH[ :~'Rff~AND SURVEYOR
6 EAST MAIN STREET N.Y.S. LIC. NO. 50202
RIVERHEAD, N.Y. 11901
server\d~ROS\01-21
1
369-8288 Fax 369-8287 KLI-.\U-Ip