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JUDITH T.TERRY �� .0` • Town Hall, 53095 Main Road
TOWN CLERK i =c4
Z P.O. Box 1179
,,t! Southold, New York 11971
REGISTRAR OF VITAL STATISTICS O
Fax (516) 765-1823
MARRIAGE OFFICER ‘:#41 of
RECORDS MANAGEMENT OFFICER = o.( jig #0 1�� Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER •ii"
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1685 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : LISO CONSTRUCTION CORP.
Address 1 : P. 0. BOX 439
City St Zip JAMESPORT NY 11947
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. SCHD REF. #R10-06-0077
Name Of Owner KUNEN, BARBARA
Mailing Address 1 P. 0. BOX 118
City St Zip CUTCHOGUE NY 11935
Property Address 1 175 BURTIS PLACE
City St Zip PECONIC NY 11958
Tax Map No. section 67.00 block 4 lot 15.001
Cross Street FASBENDER AVENUE
Building Permit Number Cross Reference:
Issue Date: 6/09/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY �$' Gy
1 Town Hall, 53095 Main Road
TOWN CLERK y P.O. Box 1179
REGISTRAR OF VITAL STATISTICS O
Southold, New York ].1971
Fax
MARRIAGE OFFICER � y ���11 Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER ='0,( 1.6 Telephone (516) 765-1800
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FREEDOM OF INFORMATION OFFICER ��
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: June 3, 1997
Transmitted herewith is a copy of application No. 1755 for a Cesspool/
Septic Tank Construction Permit submitted by:
Liso Construction Corp for Barbara Kunen
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.
Thank you.
Linda J. Cooper
* * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE
DISAPPROVE
Comments:
•
ignatur
Dated
:r •
OFFICE
OFFICE OF THE TOWN CLERK ,,,,""••
Town of Southold ��l'� �FFOtire
Judith T. Terry, Town Clerk �l/ '• Application No.
;7-5 5
rows Mall, 53095 Main Road
P. O. Box 1179 ; Construction
Southold, New York 11971 ' %J' Alteration_
Telephone ,r � r,'� $10.00 - Residential t- _
(516) 765-1801 tQl ► J_---- —
•
$25.00 - Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE G I,31 617
APPLICANT NAME: L, ( S a e..o N s G:,a K P -_4
--
APPLICANT ADDRESS: F0 ,3
SEPTIC V CESSPOOL IV �4—
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
o 1.4,a. Ery► 1La( au, LL"rrt
LOCATION MAP: Must be attached hereto before permit may be issued. r "
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY : ‘'cv a,cL, N
OWNER MAILING ADDRESS: 'C o` )( _ \kS.__ G Le.-%-4, ` `
OWNER PROPERTY ADDRESS:_/76-- ,,e
� 6 /2.II S .1)4 4. l GCv iic.
i N.Y
TELEPHONE NUMBER OF CONTACT PERSON: A l
TAX MAP NO. : Section /...47, /
„ Lot �
CROSS STREET :
BUILDING PERMIT NUMBER CROSS REFERENCE:
n -____
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RECEIVED �g ature of Appli ant
RECEIVED BY :
DATE:
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Intl THREE YEARS
FROM DAZE of MINNA1. P J
r'rl►N1Y DEPARTMENT OF HEWN SERVICES X r i-1-' 3 e r),-, at/ 9 0• .
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?, ,_cC DwS �vc �.,� s TSS /Nes. :Cec?-
-- `'rrioovAL CONSTRUCTION ONLY
I. I) 1 /FtSURYOr
- „ 9.REF.NO, ID 96 °‘ 77 0
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LOTS 98 & 99
71 of wells and cesspools shown hereon are from field' - /M/��AI�p' • N�� 2 _
, „„(1 or from data cesspools
from others. mkt C so S 4/
�c� s�rtr�Ea 18, »so F�� l�
,u ppiy and sewage disposal A T PEC . A� , lii
:his residence w conform ON/C
ds of The sv/fd* county - '-�W� n
I Health Services. OF 50117'HOL �y
CERTIFIED TO, SUI'FOLK COUNT y//77V IJ
JACK P. CHRrsr
Woo - 67 v N V