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OFFICE OF THE TOWN CLERK �c��FF01A-e,
Town of Southold � { ,q ,,, y
Judith T. Terry, Town Clerk : Z � j
Town Hall, 53095 Main Road
P. 0. Box 1179 %cn
Southold, New York 11971 Oqt,>, '` 0�-►••�
Telephone ! * 1 ,),-
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL.
Permit No. 144 Residential X
Non-Residential
Fee $ 10.00 (paid)
Septic Cesspool X
PERMIT ISSUED TO:
NAME: Ralph and Ellen Peluso
ADDRESS: 77-03 101st Avenue
Ozone Park, New York 11416
DESCRIPTION OF PROPOSED CONSTRUCTION or ALTERATION
New Single Family Dwelling
LOCATION OF PROPOSED CONSTRUCTION or ALTERATION:
OWNER OF PROPERTY: Ralph and Ellen Peluso
OWNER MAILING ADDRESS: 77-03 101st Avenue
Ozone Park, New York 11416
OWNER PROPERTY ADDRESS : 1795 Platt Road
Orient, New York
TAX MAP NO. : Section 18 Block 6 Lot 26.4
CROSS STREET: Main Road
BUILDING PERMIT NUMBER CROSS REFERENCE:
Judith T. Terry
Southold Town Clerk
DATE : April 15, 1987 -
(TOWN SEAL)
77
c� tV F- ' Town Hall, 53095 Main Road
. f ?y P.O. Box 1179
F Southold, New York 11971
4 i S r Jo
JUDITH T. TERRY �•-•.•••ii ss TELEPHONE
TOWN CLERK (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
•
April 15, 1987
•
Ralph and Ellen Peluso
77-03 101st Avenue -
Ozone Park, New York 11416
Re: 1795 Platt Road
Orient, New York 11957
Enclosed herewith is the Construction, Alteration or Modification
Permit for a Septic Tank or Cesspool System for which you applied.
Please be advised that each owner of real property operating an
on-site sewage disposal system, such as a septic tank or cesspool must,
prior to such operation, possess in the name of the owner an Operation
Permit for the system. The Operation Permit is issued by the Town
Clerk's Office.
The fee for an Operation Permit is ten dollars ($10. 00) for
residential use and twenty-five dollars ($25.00) for non-residential.
Please have the owner complete the enclosed Application for an Operation
. Permit and return it to this office along with the proper fee.
For your general information I have enclosed an Informational
Bulletin regarding the Scavenger Waste Laws adopted by the Southold
Town Board. Should you have any questions pertaining to either permits
or the Scavenger Waste Laws, please do not hesitate to contact this
office. We will be glad to assist you in any way possible.
Very �t^ruly ours, /0
Judith T. Terry
Southold Town Clerk
Enclosures (3) .
JTT/Ijc
OFFICE1OF THE TOWN CLERK
Town of Southold
Application No. /1
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road Construction
P. 0. Box 1179
Southold, New York 11971 Alteration
Telephone Residential c� _
(516) 765-1801 Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. / y'
Fee .$/O3 `— 4r( /
DATE `O/ /9S2
APPLICANT NAME: /7)4 an e) i /ems 24"0
APPLICANT ADDRESS: X7'7 - C) 3 ( U ( Ave - (-7( ) 3-307
0'z One lam lc ti °/' r 1 -(6 r ),74_ Do) $4y
SEPTIC CESSPOOL J
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
.).<[9- 4-xj.L talkLe-e-1.4.V
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: IC-(p k ouc, E (( et, A•-e(.rc'
OWNER MAILING ADDRESS: /7 9\r /37,9--/-i- -Rd, 01, -erti
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section I Block 6" Lot a 6- 'f-
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of Applicant
,'c'%/,o c h
RECEIVED BY: ( �
Town CI k's Offi e
DATE:
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