HomeMy WebLinkAboutPellegrino, Immaculate ,,%OFFO4=c
ELIZABETH A. NEVILLE a� Gy� Town Hall, 53095 Main Road
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TOWN CLERK C P.O. Box 1179
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REGISTRAR OF VITAL STATISTICS Fax (631) 765-6145
MARRIAGE OFFICER .�.ti �1�,
RECORDS MANAGEMENT OFFICER '/Q �a�l'i� Telephone (631) 765 1800
FREEDOM OF INFORMATION OFFICER _ 0���
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2335 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : IMMACULATE PELLEGRINO
Address 1 : 193 NELSON STREET
City St Zip HAUPPAUGE NY 11788
Descripton of Proposed Construction or Alteration
ADDITION OF OVERFLOW TO EXISTING SYSTEM.
APPLICATION APPROVED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES.
EXCAVATION INSPECTION REQUIRED.
Name Of Owner PELLEGRINO, IMMACULATE
Mailing Address 1 193 NELSON STREET
City St Zip HAUPPAGUE NY 11788
Property Address 1 MINNEHAHA BLVD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 87.00 block 3 lot 38.000
Cross Street OWAISSA AVENUE
Building Permit Number Cross Reference:
Issue Date: 6/02/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE ���_ • y ; Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
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REGISTRAR OF VITAL STATISTICS Southold, New York 11971
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MARRIAGE OFFICER Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER =y'flpl ����°, ;" r '� elephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: June 1 , 2000
Transmitted herewith is a copy of application No. 21123 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Immaculate Pellegrino
Please review the application and location map and advise if this office may
issue the permit.
Please complete the form below and return it to this office.
Thank you.
Linda J. Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the following recommendation:
APPROVE -
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
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Date
OFFICE OF THE TOWN CLERK ��' I��FULK'•"
TOWN OF SOUTHOLD � � COG Application No. aYg
ELIZABETH A.NEVILLE,TOWN CLERK
P.O.BOX 1179Construction
SOUTHOLD,NEW YORK 11971 =v T
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Al SURVEY OF PROPERTY
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coo AT LAUGHING WATERS
ai S TOWN OF SOUTHOLD
3• SUFFOLK COUNTY, NEW YORK
4 F 1000-87-03-38
w DECEMBER 22, 1998
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ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION P C .,l,_ • yV•.• P.C.
OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW ,-.' �\
EXCEPT AS PER SECTION 7209-SUBDIWSION 2. ALL CERTIFICATIONS (576) z
HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF P. 0. 80
SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR 1230 TRAVELER STREET 98-352
WHOSE SIGNATURE APPEARS HEREON SOUTHOLD, N.Y. 77977