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ELIZABETH A.NEVILLE % Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS
,, t! Southold,New York 11971
MARRIAGE OFFICER ; T ��� Fax (631) 765 6145
RECORDS MANAGEMENT OFFICER �__ ID 4)iii Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
SOUTHOLD ' INHPHESEIDSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2663 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : ROBERT & RITA PELLEGRINI
Address 1 : PO BOX 1201
City St Zip SOUTHAMPTON NY 11968
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 #R10-01-0104
Name Of Owner PELLEGRINI, ROBERT & RITA
Mailing Address 1 C/O INTERSCIENCE RESEARCH
PO BOX 1201
City St Zip SOUTHAMPTON NY 11968
Property Address 1 1205 PT PLEASANT ROAD
City St Zip MATTITUCK NY 11952
Tax Map No. section 114.00 block 1 lot 4.000
Cross Street WESTPHALIA
Building Permit Number Cross Reference:
Issue Date: 9/25/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
M ] (//n
t. ^ 3
ELIZABETH A.NEVILLE to g� t.4 Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
0. Southold, New York 11971
REGISTRAR OF VITAL STATISTICS � ® � a , �
MARRIAGE OFFICER :t t, L "4.
��1� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER `i s ��
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: September 24, 2001
Transmitted herewith is a copy of application No. 2753 for a Cesspool/Septic Tank Construction
Permit submitted by:
Inter-Science Research Associates,Inc. for Robert and Rita 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.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and locatio map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments: rr `' „it r AireA'��t�,� '�
Signature
Dated //2--c-///or
a
4.
r • . ,`•',,,ui..,__,'.
• OFFICE pF THE TOWN CLERK ,�i,
. TOWNOFSOUTHOLD Application No. 02 7,5
ELIZABETHA.NEVILLF,TOWNCLERK � Construction
`` P.O.BOX 1179 % __
SOUTHOLD,NEWYORK11971 % 1,1 Alteration
,
•Telephone - 4 .0*/ ' $10.00 -Residential
(631) 765-1800 s"----:_4r0./ I,�'�� • $25.00 -Non-Residential
.----- o
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
•
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT ,
SEPTIC TANK or CESSPOOL
Permit No. •
Fee .$
DATE September 11, 2001
APPLICANT NAME: Robert and Rita Pellegrini
APPLICANT ADDRESS: c/o Inter-Science Research Associates, Inc.
PO Box 1201, Southampton, New York 11969
SEPTIC X CESSPOOL X -,
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
Demolition of existing home, removal of existing sanitary system; Construction
of new home with accessory structures; Installation of new sanitary system.
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION': 't®;
pt. p��sma ®,�ll�+eP1teR.D•)
Nktraugt
OWNER OF PROPERTY: Robert and Rita Pellegrini Stia% tat20® Ip4 a (tm 4
Agent OMIR MAILING ADDRESS: c/o Inter-Science Research Associates, Inc.
PO Box 1201, Southampton, New York 11969
PROPERTY ADDRESS:3
So+rL-I• ,
TELEPHONE NUMBER OF CONTACT PERSON: (631) 283-5958
TAX MAP NO. : Section 114 Block 01 Lot 04 •
CROSS STREET: Silkworth, Westphalia
BUILDING PERMIT NUMBER CROSS REFERENCE: Building Permit Application
submitted; Decision pending
Si.ø1 . - •,I )P 4 * - Agent
Scat? >DOB( �� I &NTGR.-SCIENG6
RECEIVED BY: • ASSOCIK1IS,IWC' ific
DATE: $9/4, / , (
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