HomeMy WebLinkAboutCangero, Tom ,'o"\OS�FFO(,�c0
JUDITH T.TERRY �� � Gy1 Town Hall, 53095 Main Road
cf.
TOWN CLERK ` y = P.O. Box 1179
$ Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER : ifJ O�',1�� Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER '! * '1►�oi� Fax
(516) 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. 1495 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : TOM CANGERO
Address 1 : 375 RACCOON ROAD
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
ADDITION OF A NEW CESSPOOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION
INSPECTION REQUIRED.
Name Of Owner CANCERO, TOM
Mailing Address 1 P. O. BOX 81
City St Zip MATTITUCK NY 11952
Property Address 1 375 RACCOON ROAD
City St Zip MATTITUCK NY 11952
Tax Map No. section 106.00 block 10 lot 10.000
Cross Street COX NECK ROAD
Building Permit Number Cross Reference:
Issue Date: 6/25/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
_ -.
- / (7Z ci 13
��, 4 , e -
JUDITH T.TERRY o= Town Hall, 53095 Main Road
TOWN CLERK %% N Z P.O. Box 1179
$Southold, New York 11971
REGISTRAR OF VITAL STATISTICS `�
MARRIAGE OFFICER ..4., .Vole Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER : O! iNg *a�. Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK ----r - �_�_ �_
TOWN OF SOUTHOLD fu �' �5 ,
TO: Southold Town Building Department
7
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: June 17, 1996
Transmitted herewith is a copy of application No. 1559 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Tom Cangero ( work to be done by Grefe ) .
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.
i77 :'
Signature
Dat
OFFICE OF THE TOWN CLERK ",,,,
Toitn of Southold > ` FF Application No. 7S S /
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road Construction
P. O. Box 1179
Southold, New York 11971 4 x Alteration
Telephone � $10.00 -Residential
(516) 765-1801
> $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL C U IgG 7 /L
Permit No. /(/'C
Fee $ /
DATE /7/ 6
6
APPLICANT NAME: / G14-7 d--"9/YGe GG
APPLICANT ADDRESS: 7 2 SJ )7D Off-
SEPTIC CESSPOOL >C
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
�f� £ i$poZ
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY:
OWNER MAILING ADDRESS: f G
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section /#i Block f " Lot 10
CROSS STREET: Cb)C , ) EC /C t2i
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signatur of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
•
•
I
,�, .Z�.
--_:h_N_N ., . ."-^/Z 3a >�KiODB
,rivcE
✓ / 1 i
IT
1
ke1 j Porio , fn ik
a1 i
It J
ti QIV `i
/r�,r >i
\ 476, :, () 21,e)N .rz�,3, 1ptV 'l
at h N
,at 366',,8' —.4 /25,do' ,
izz5.3V v ../B�a7•/J''er--i-- dip
v
r1 L , •J/e`a_ 7'/3''E-_, /z -eo , &i
\ ,e4 6N l z4/',e0, ) /e41/9.4P.b �
Unauthorized alteration or addition
to this survey Is a solation of
•
Section 7108 of des New York stele
ill
Eduadon Law.
Copies oft*survey me.sit larMq
Q emmboaesd esti Meal net M erefdlsed
land sutWiOni Inked seal at
41 tobeamild bueailp. 7--- £o LA O
41 Guarantees lnafi0� fera
d en 11th 6'r+ �t'° S�'N,
only m the pennon let stem b stray � .j. 1 E 1V, '9`
is prepared,and en debele.rdue v IV,
.
ending institution Medd SWI ant 0 - .. O o\
. to the assignees of the WWII tlew/a+. r • , al 9
Guarantees are not transferable ° ^^-% ' -.1 v` ,
Com, to additional institutions or abaettuastt z f' Z.
owners. / � 4 ;
,NEWV— -
SuavvV,So eiT ont964'J,�'b6'L v vG"9.49Ne,2�''9468,e ' ANTE, iVS.e yev l.Y•4ND�DY�'�.t'%
1r�N0�1J,eYFYd,t?
. - d., - / ucc- o N- - - , , y Re,nor 4€
449
gauryoiv,My, 1/97/
.06•RIe,/4 416'