HomeMy WebLinkAboutPellicano, Russell :OC)'%I ULJI C t
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Town Hall, 53095 Main Road
:4 Town
0 Obi P.O. Box 1179
• Southold, New York 11971
JUDITH T.TERRY 11 '•�1 TELEPHONE
"TOWN CLERK
��••""� (516) 765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1581 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : RUSSELL A. PELLICANO
Address 1 : 359 PENNSYLVANIA AVENUE
City St Zip BAY SHORE NY 11706
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. SCHD REF. #R10-06-009
Name Of Owner PELLICANO, RUSSELL A.
Mailing Address 1 359 PENNSYLVANIA AVENUE
City St Zip BAY SHORE NY 11706
Property Address 1 9680 NORTH BAYVIEW ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 79.00 block 8 lot 13.000
Cross Street
Building Permit Number Cross Reference:
Issue Date: 12/17/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY ����� ��1 Town Hall, 53095 Main Road
TOWN CLERK ; y Z P.O. Box 1179
REGISTRAR OF VITAL STATISTICS % O
t! Southold, New York 11971
ifi �1# Fax (516) 765-1823
-
MARRIAGE OFFICER \ *. aO��i� Telephone (516) 765-1800
RECORDS MANAGEMENT OFFICER : 1 * `�►
FREEDOM OF INFORMATION OFFICER -•v„. 01°
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
EC 3
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: December 12, 1996
Transmitted herewith is a copy of application No. 1649 for a Cesspool/
Septic Tank Construction Permit submitted by:
Russell A. Pellicano .
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.
Thank you.
4t_ot.�
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following reco endations:
APPROVE '
DISAPPROVE
Comments: 5r;of ,C�,-� CS4 /// /lJ 6 ` 7 - 6 e
RECEIVED i
Ar: 1
4l .CI `�
�
DEC 1 71996 Sig ature
"
; '''...‘
Dated
Southold Town Clerk
•
• OFFICE OF THE TOWN CLERK
Town of Southoldwiz/JudithI. d � Pitire
T. Terry, Town Clerk
•
Town Ilall 53095 MaIn Road
/ct OO- OGy Application Ido.
. O.0. Box 1179 j� tr,
Southold, New York 11971 ' • ; Construction Alteration ---_' --
Telephonefeir_0 '�•
(516) 765- 1001 � $10.00 Residential
ti
O $
nrt $25, 00 - Non-ii dermal
TOWN OF SOUTIIOI_r)
sot•rl1OL•D WASTEWATER DISPOSAL DISTRICT
APPLNAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANI< or CESSPOOL
Permit No.
Fee $
n DATE
APPI_I•CANT NAME: rCVSs - - - ---_- __
APPI-ICANT ADDRESS: � `'-'-rcgK�-
3S 9fE,yyr9e4vAovi4n_�`1
C. a/ .-- _ y
SEPTI
_ssCESSPOOL
oFscRlP'rloN of PROPOSED
CONSTRUCTION OR A
G N mr- A T'i N ce-_.t�9yai/ v Duce// l r E R A 1'I O N __ _ — --
LOCATION MAP; • Must be attachedhereto before� - '`�'--_..-_- ---- _
LOCATION permit may be issued.OF PROPOSED CONSTRUCTION
OWNER OF 1 ION OR ALTERATION:
hROPE11'Y; n
OWNER -�sT�f�_.._�__ 1-QI�tCq"[o
MAILING ADDRESS: 3s-9 P
•
OWNER PROPERTY A DDR ESS:
TELEPHONE NU _ . ._ //_ 79/_-_ -.
MISER OF CONTACT PERSON:
___--------...__
TAX MAP NO, ; Sec 66_oy���`
on_o _Blocic -- ---___-
CROSS STREET: SCIAccr�p -�,co oaa
--
BUILDING PERMIT NUMBER CROSS REFER E ^---'"
-Signature
RECEIVED
BY:k_S-
Town Cierlc' O
DAT•E :
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