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JUDITH T. TERRY L Town Hall, 53095 Main Road
TOWN CLERK ` rZ P.O. Box 1179
REGISTRAR OF VITAL STATISTICS irs ` Southold, New York 11971
MARRIAGE OFFICER y0 �.. �� Fax (516) 765-1823
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(516) 765-1801
jit OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 33 N Residential Non-Residential X
Fee $ 25.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : ROBERT PELLEGRINI
Address 1 : 4515 STILLWATER
City St Zip CUTCHOGUE NY 11935
Descripton of Proposed Construction or Alteration
CONSTRUCTION OF SANITARY SYSTEM AT WINERY.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES.
Name Of Owner PELLEGRINI, ROBERT & JOYCE
Mailing Address 1 4515 STILLWATER
City St Zip CUTCHOGUE NY 11935
Property Address 1 23005 MAIN ROAD
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 108.00 block 1 lot 8.007
Cross Street ALVAHS LANE
Building Permit Number Cross Reference:
Issue Date: 4/10/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRY % .. Town Hall, 53095 Main Road
TOWN CLERK =O T • P.O. Box 1179
REGISTRAR OF VITAL STATISTICS : ilk : Southold, New York 11971
Fax (53
MARRIAGE OFFICER •
o �.47" �� Tel ph nel(516)765-1
57651801
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OFFICE OF THE TOWN. CLERK n @4
ki'�
TOWN OF SOUTHOLD i
t APR — 81992
To: Southold Town Code Enforcement Officer
From: Linda Cooper, Southold Town Clerk's Office TO1�N
Dated: April 8, 1992
Transmitted herewith is a copy of application No. 843 for a Cesspool/
Septic Tank Construction Permit submitted by:
Robert Pellegrini .
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.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE
DISAPPROVE
•
Comments: $4,4 s-..Lota.e .*.t& a ;.%ALL s44)1. (14,1Q-
Girtscst , 1 Tic �'
tU
\70:73}cYt,
Signature
q\ 111\1112.
Dated
OFFICE OF THE TOWN CLERK c.31FO
Town of Southold 0�� ��Q�
�`� ` ": Application No. J
Judith T. Terry, Town Clerk � `r'. � i - dy '
Town Hall, 53095 Main Road o �.�� =� �
P. O. Box 1179
cn i •, Construction
Southold, New York 11971 �• Zu• Ai' Alteration
4 r/
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Telephone 1 Residential
(51 6) 765-1301 "' Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT .
•
SEPTIC TANK or CESSPOOL
Permit No.
Fee $ w
DATE Afrii 2. 1992
APPLICANT NAME: 1' )13e,r1". 1; rinsi
•
APPLICANT ADDRESS: 4ei l ,t fi11u -br
-b+61 r. Ni0 119
SEPTICX_ x
CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
109 t.-10 — CO /n, e
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CON
RUCTION OR ALTERATION:
OWNER OF PROPERTY: tr#ter __ , EP r„ '
OWNER MAILING ADDRESS: ! rIr. efli 44 ,
OWNER PROPERTY ADDRESS:
514,21rallin Asp
TELEPHONE NUMBER OF CONTACT PERSO : 75.4-ezygebo,
TAX MAP NO. : Section - � Block C)l
Lot .7
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:..
/.I
n. re of Applicant -
RECEIVED BY:
c�. i —Cl-� ✓
Town/CI -�
ce
DATE:
APR ) 199_
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