HomeMy WebLinkAboutPugliese, Ralph ,40--
ELIZABETH A. NEVILLE ���0 'y�: Town Hall, 53095 Main Road
TOWN CLERK Z P.O. Box 1179
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REGISTRAR OF VITAL STATISTICS ��,$ Southold, New York 11971
MARRIAGE OFFICER �� .f� �� Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER �Ol $7-,11° Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 3141 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : RALPH PUGLIESE
Address 1: PO BOX 467
City St Zip CUTCHOGUE NY 11935
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR ONE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. REF #R10-03-0097
Name Of Owner PUGLIESE, RALPH
Mailing Address 1 PO BOX 467
City St Zip CUTCHOGUE NY 11935
Property Address 1 BRIDGE LANE
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 97.00 block 1 lot 12.006
Cross Street MAIN ROAD
Building Permit Number Cross Reference:
Issue Date: 2/13/04 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
ofFot�.�oG\ '3 J�I )
ELIZABETH A.NEVILLE �'= y� Town Hall, 53095 Main Road
TOWN CLERK o - P.O. Box 1179
H Southold,New York 11971
REGISTRAR.OF VITAL STATISTICS � v' fit
MARRIAGE OFFICER 1iL ����', Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER �_�Qiffe �a),1 Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER ��,��� southoldtown.northfork.net
-,,,,,,
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: February 6, 2004
Transmitted herewith is a copy of application No. 3278 for a Cesspool/Septic Tank Construction
Permit submitted by:
Ralph Pugliese
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.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments: ► `�,�.�� �� _
•
Signature
Dated
ELIZABETH A. NEVILLE 1 tii Gy�; Town Hall, 53095 Main Road
TOWN CLERK ' . ; P.O. Box 1179
Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS %• v Al
• • MARRIAGE OFFICER
O ,, .1C �� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER y� *1.° Telephone Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER =O1 *„et southoldtown.northfork.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. 3.178
Permit No.
Applicant Name i' 1 +4/ PC,I1;ES E
Applicant Mailing Address A,.7O5 vci' ), 4 ti'f' Ai2 60 7
C irii_40 c a e
►A//: // 7.35
Septic Tank or Cesspool
Brief Description of Proposed Construction or Alteration
Location of Proposed Construction/Alteratio : )
Owner of Property: Rel,/ A G G�;k5/
Owner Mailing Address: /D, Q Qc7 67
C07cJdcv4r i' . l/?3L(
Owner Property Address: S/9-M<-- 4.5 /go vL
Name and phone number of contact person &//00 A / /L; 4;k.5 t 7-71"P_C 7
Tax Map No: Section on/19V--0 Block
7 °I Lot P o 1 ..k,
Cross Street /in; ii/ Rd��
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH D T ENT APPROVAL
1 ql , i_ii
Signa ure s 'Applicant Date
Received by:
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r SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES W �— • cn N.
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