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SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 3320 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : RALPH PUGLIESE JR
Address 1: PO BOX 481
City St Zip CUTCHOGUE NY 11935
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. REF #R10-04-0118
Name Of Owner RALPH PUGLIESE JR
Mailing Address 1 PO BOX 481
City St Zip CUTCHOGUE NY 11935
Property Address 1 LESLIE ROAD
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 97.00 block 4 lot 17.002
Cross Street LESLIE ROAD
Building Permit Number Cross Reference:
Issue Date: 5/18/05 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE 1 /5 lQ Town Hall, 53095 Main Road
TOWN CLERK it4,, P.O. Box 1179
REGISTRAR OF VITAL STATISTICS N Southold, New York 11971
MARRIAGE OFFICER ‘` Fax 111 Fax (631) 765-6145
%RECORDS MANAGEMENT OFFICER -(4, A •1/ Telephone (631) 765-1800
FREEDOM OF INFORMATION.OF CER l couN i,�i o' southoldtown.northfork.net
1,1‘ i,�i,, OFFICE OF THE TOWN CLERK
\ AY ' q . L1 TOWN OF SOUTHOLD
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,`.. Southold o ilding Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: May 6, 2005
Transmitted herewith is a copy of application No. 3465 for a Cesspool/Septic Tank Construction
Permit submitted by:
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 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: ,...4=s•
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Signature
91447 /.0; OaltS—
Dated
o��gUFFO(,�cV
'I�,ELIZABETH A.NEVILLE ��0 �\ Town Hall, 53095 Main Road
TOWN CLERK ��� - , P.O. Box 1179
Z
REGISTRAR OF VITAL STATISTICS ‘`.°O
H W i Southold, New York 11971
MARRIAGE OFFICER : O 1Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER \ �,is' Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER '�O•� 4i1' •I Dsoutholdtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
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Residential @$10 ✓ or Non-Residential @$25 Application No. 3`'I L-�
n/ Permit No.
Applicant Name aRt...Q ti- PV .bsF sc 'DI-
Applicant
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Applicant Mailing Address Po (So x 'IV
__k06-L Nil 111. s - o`f (
Septic Tank or Cesspool
Brief Description of Proposed Construction or Alteration C b u S n t'c.r.a u o c Ncw
Location of Proposed Construction/Alteration:�
Owner of Property: If-A-G tt Pt)C- cseS�` S�
I�'
Owner Mailing Address: 0 (Jam LAI
Co l c ki06-Le N1 I kS 3s-- o1 /
Owner Property Address: A0€6-• E S i A icS
CFP- L cci 20 AD , C,-)7 C how
Name and phone number of contact person c(1 It - (J 3 l - Y31-9 0 5(o
Tax Map No: Section oCI) Block 1` 'S.,- tiLot I/, 2
Cross Street L u r- kom
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SUR WITH HE TH'DEPARTMENT APPROVAL
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Signa Applicant Dat
Received by lcv\
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SURVEY711,
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OFLOT # 2 __ _ -
II )UF?Own -ou ~ N
MAP OFKAY I ESTATES" �+:��:ie— .',...7C.:a � ' .i♦LI RVICEs
FILO IEu. 13, IG 2 _ Ac 011412 PERMIT FOR APPROVAL 4F GON57RtrwCT10N FOR I
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SITUATE: GUTGHOC�UE SINGLE FAMiL� RESIDENCE ONLY A
TOWN: L.17 s
FOLK COUNTY, 1•h' �J�,� d� .�.:�. ; .gyp _
SURVEYED: 01-01-01 ��'?RflYEp 0
PROPOSED HOUSE 01-23-04 ���„� }:c1?
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SUFFOLK COUNTY TAX # �fl ` AXIMU (fir y, �, ,7.1
1000-G11-4-11.2
EXPIRES r ROOMS G S�r" '
�►t? . \ A: O�1 047F, OF APPROVAL a' ter'
CERTIFIED TO: me " '"
RALPH PUOLIESE,JRr17h
COMMONWEALTH LAND �? �.�
TITLE INSURANCE COMPANY t1 \ ` n •-�
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"" tons aro not transferobie m ode¢orninsueot on:
TOTAL AREA = Q0,039 S.F. JOHN C. EHL 7—` AND SURVEYOR
AREA EXC. R.O.W.= 80,102 S.F. 6 EAST MAIN STREET N.Y.S.LIC.NO. 50202
GRAPHIC SCALE I 60' RIVERHEAD,N.Y. 11901
�� _ 369-8288 Fax 369-8287 REF.\\Hp server\d\PROS\01-211.pro
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