HomeMy WebLinkAboutLustenring, Charles •
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JUDITH T.TERRY � _ G'l%�`` Town Hall, 53095 Main Road
TOWN CLERK ; y Z P.O. Box 1179
v f ,� Southold,New York 11971
REGISTRAR OF VITAL STATISTICSO
MARRIAGE OFFICER �:-y ,�� Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER = 0.( , ��eel Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER ,•i"
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1653 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : LISO CONSTRUCTION CORP.
Address 1 : P. O. 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. #R10-94-83
Name Of Owner LUSTENRING, CHARLES
Mailing Address 1 103-25 114 STREET
City St Zip RICHMOND HILL NY 11419
Property Address 1 KNOLLWOOD LANE
City St Zip MATTITUCK NY 11952
Tax Map No. section 107.00 block 6 lot 6.000
Cross Street WICKHAM AVENUE
Building Permit Number Cross Reference:
Issue Date: 4/30/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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ACP (1lkcO ,l
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s i Town Hall, 53095 Main Road
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P.O. Box 1179
�1, ��P i Southold, New York 11971
JUDITH T.TERRY %. 1 + TELEPHONE
TOWN CLERK ,`%.v.��• (516) 765-1801
REGISTRAR OF VITAL STATISTICS
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD t t5 O V"fi
T0: Southold Town Building Department ;r 2
FROM: Linda J. Cooper, Southold Town Clerk's Office
l i 4
DATED: April 21 , 1997 W_. ... _._..
Transmitted herewith is a copy of application No. 1724 for a Cesspool/
Sepik: Tank Construction Permit submitted by:
Liso Construction Corp. for Charles I Ilstenring •
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:
RECEIVED
APR 2 , 1„7si27:44.Y
gnator
"'. r:1thold Town Clerk Dated
4
OFFICE Or THE TOWN CLERK ,.,,""--
Town of Southold ��',� Q(�`,D
Judith T. Terry, Town Clerk ;` � l/ '� Application No. 70j y
41
Town Hall, 53095 Main Road `
P. O. Box 1179 ; Construction
Southold, New York 11971 Alteration
Telephone = j'y �Q�'� $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
Permit No.
Fee $
DATE l9/.02 //f 7
APPLICANT NAME: LI so c .0,1V s t . Lo, , P.
APPLICANT ADDRESS: 3o L3c1 J�p� �sPi-1 N-1/4-(
SEPTIC i,, CESSPOOL V -
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LLD t1-,tt= PLn.c.
wC,,LcA.4G.
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: C ),,,, Rt/vG,
OWNER MAILING ADDRESS: b
�__- 3 /14/77#45711,5‘A, }?a4..s-1,704.44) 16AL.. /4V
OWNER PROPERTY ADDRESS: l•G 1401.1. wV Yl o _Z`„,4c K.Z/
TELEPHONE NUMBER OF CONTACT PERSON: L a L -.4 8'5-4
TAX MAP NO. : Section /p 7 Block OC Lot IC
CROSS STREET: N,v
BUILDING PERMIT NUMBER CROSS REFERENCE:
RECEIVED
Signature of Applica it
RECEIVED BY: APR 21 1997
Town Clerk's Office
DATE: Southold Town Clerk ___
FL,z Z•$ ..
••.• • ••--r "� SUFFOLK COUNTY DDAR'IMENT OF HEALTH SERVICES
/' ^-. .04111.9):40.43400
D.xvy vLa.v,f y ` PERMIT FOR APPROVAL OF CONSTRUCTION FOR A
r acs vo lIGLE Y RESIDENCE ONLY
3' "__ B I DATENOV S . ' a .. a" 'W.:7
.e .ti• rcra If '
',��'�r�..y APPRO
7/ _ \... \
FOR iJ11+t OF�BEDROOMS
�o� '�'�✓ $ EXPIRES TREE YEARS FROM DATE OF APPROVAL
rJeSrs tr�+wo `o
i7 � ___j Approved in accordance wit Board of Review
EXCAVATION INSPECTIO REQUIVA /e, / determination dated 16 3 019'10
FOR SANITARY SY •TEM �C'/ 'o c' ,A►D _ L 9Nt
BY HEALTH OEPAR ENT J'z•O --- ------ _
__A4 e- /Y 7/' Z4/.07/ •P.�3 SUBJECT TO COVENANTS&RESTRICTIONS UBE r e 4 r
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