HomeMy WebLinkAboutRengifo JUDITH T. TERRY �► Town Hall, 53095 Main Road
TOWN CLERK • p T ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Lr2 Southold, New York 11971
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MARRIAGE OFFICER ® �' Fax� Fax (516) 765-1823
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1003 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : PECONIC CESSPOOL
Address 1 : P. O. BOX 972
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
ADDITION OF A NEW OVERFLOW TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. KEEP 10' APART. EXCAVATION INSPECTION
REQUIRED.
Name Of Owner RENGIFO, RICARDO L.
Mailing Address 1 3-33 PARSONS BLVD.
City St Zip WHITESTONE NY 11357
Property Address 1 SHORE DIRVE
City St Zip GREENPORT NY 11944
Tax Map No. section 47.00 block 2 lot 32.000
Cross Street SILVERMERE ROAD
Building Permit Number Cross Reference:
Issue Date: 5/25/93 Judith T. Terry
Southold Town Clerk
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. t►`t?, i MAY 2 41993 }'`,4!'' c)Imre®�'
JUDITH T. TERRA' " "" _�l -I\vi�' Town Hall, 53095 Main Road
TOWN CLERK LTOWN.N a'C)L91 110Lp .,c=a1 P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Els �� Southold, New York 11971
��' Fax (516) 765-1823
MARRIAGE OFFICER ® � •
__ 1 /1111 �1a° �� Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK '
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: May 24, 1993
Transmitted herewith is a copy of application No. A1031 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
PeConic Cesspool for Ricardo L. Rengifo .
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.
4.4---11_,c.e...---
Linda
J. Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the following commendation:
APPROVE -
DISAPPROVE -
COMMENTS:
....44&_,„_,11.7e..----
EXCAVATION Qii •/ `t
EXCAV1\ SPECflON Sign.ture
REQUORE - D£/� � % 3
OFFICE OF THE TOWN CLERK ,,,'",,,"
Town of Southold .sol fglir
Judith T. Terry, Town Clerk ;�'0%� ��l/� Application No.A/ 03/
Town Hall, 53095 Main Road Z Construction '
P. O. Box 1179 ' ; o ` • m .
Southold, New York 11971 1 Alteration
Telephone ;`'O -�ir $ $10.00 - Residential �'
(516) 65-1801 =���1 l l'
, $25.00 - Non-Residential
,F-o�
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE ) � 9
APPLICANT NAME:• � / ✓ i '.
APPLICANT ADDRESS: 97z.,
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: k/C- 4--,e- 449 2', we----41Gin,
OWNER MAILING ADDRESS: _3-33' Pa,;, ,,,,,,„
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OWNER PROPERTY ADDRESS: 4,41".4 ,r_- dl J., ,,
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TELEPHONE NUMBER OF CONTACT PERSON: X92- 7C.rU
TAX MAP NO. : Section 1,17 Block 2 .Lot -
CROSS STREET: ._
BUILDING PERMIT NUMBER CROSS REFERENCE:,/
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Signature of Applicant
RECEIVED BY: es s _,24,:a
To Jerk's Office
DATE: RECEIVED s
MAY 2 41993 , - ' ` '
Town Clerk Southold ; ` .
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