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JUDITH T. TERRY z Town Hall, 53095 Main Road
TOWN CLERK p T P.O. Box 1 179
REGISTRAR OF VITAL STATISTICS ; Southold, New York 11971
MARRIAGE OFFICER =V � � Fax (516) 765-1823
_'/�,. �� Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 966 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : LISO CONSTRUCTION CORP.
Address 1 : P. O. BOX 439
City St Zip JAMESPORT NY 11948
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILY DWELLING WITH SANITARY SYSTEM.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES ON 2/4/93.
Name Of Owner EDSON, LEWIS
Mailing Address 1 MAIN ROAD
City St Zip SOUTHOLD NY 11971
Property Address 1 CROWN LAND LANE
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 109.00 block 2 lot 12.006
Cross Street MAIN ROAD
Building Permit Number Cross Reference:
Issue Date: 4/02/93 Judith T. Terry
Southold Town Clerk
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JUDITH T. TERRY ; Z < : Town Hall, 53095 Main Road
TOWN CLERK z G T P.O. Box 1 179
REGISTRAR OF VITAL STATISTICS ‘'....%0
� Southold, New York t 1971
V� •% Fax (516) 765-1823
MARRIAGE OFFICER . O Or •
x (�------�^.-=ar'° =_zwei� �1D •� Telephone (516) 765-1801
f '.`r k b 2118 OFFICE OF THE TOWN CLERK
L,__,.,,�:_.,,., __ TOWN OF SOUTHOLD
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TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: March 2, 1993
Transmitted herewith is a copy of application No. 992 for a Cesspool/
Septic Tank Construction Permit submitted by:
Liso Construction Corp. for Lewis Edson .
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 K
DISAPPROVE
Comments: envoi` tj orl Cjaftb.Z%4k 1AAA ca,...eQ
Gtras-D l#41 Z,,L 7. $ e.,,. Ifaz,:sds, aft
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Signature
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Dated
OFFICE OF THE TOWN CLERK C,OFOG1
Juditown of h T. Terry,
uthold Town Clerk ��O Cly Application No. 9
..0
Town Hall, 53095 Main Road ' Construction P. O. Box 1179 ���� Alteration
Southold, New York 11971
Telephone .0l [ 'N#/ Residential L�
(516) 765-1801 Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 9 t' -
Fee $ /O
DATE I ly -��- ?j 14I.12
APPLICANT NAME: l . P .
APPLICANT ADDRESS: Po 4.0 )4 `-{ 3ct �/Llttc_,‘ S LA-,
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,S •--L Aa �s /)apt N-�
SEPTIC /CESSPOOL L.Z.
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: L t w .s 5O (
OWNER MAILING ADDRESS: rl 11-1. bui.Q 5 .: 6aaL �� ►`l-�(
OWNER PROPERTY ADDRESS: G L. a.i„“N 1-A.r•4.6. .
TELEPHONE NUMBER OF CONTACT PERSON: L. A M 1 Lt se, _7a _4? L
TAX MAP NO. : Section /01 Block 02. Lot / .2. G
CROSS STREET: ti' < r� R 1' -
BUILDING PERMIT NUMBER CROSS REFERENCE:
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,�J Signature of Appli nt
RECEIVED BY : / �` i
Town Clerk's 0 ' e
DATE:
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SUFFOLK CO.HEALTH DEPT.APPROVAL
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' } , r, , MAP OF PROPE(2TY
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J1C/�NC STATEMENT OF INTENT
{t 4' ,14y'i f _ AT I I THE WATER SUPPLY AND SEWAGE DISPOSAL
O 'I•;� i i `. - CUT`;,,,4�UE SYSTEMS FOR THIS RESIDENCE WILL
:- 7 ,' `aI',' cg. a' "f�C CONFORM TO THE STANDARDS OF THE
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/'4 m Otrtf -VA-"', • 7,r;s'0 / SUFFOLK CO.TAX MAP DESIGNATION:
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LICENSED LAND SURVEYORS
GREENPORT NEW YORK
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