HomeMy WebLinkAboutLesica, Peter •
OFFICE OF THE TOWN CLERK ��FRA- -
Town of Southold - �� OG
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road
P. O. Box 1179 ,c.r3
Southold, New York 11971 O .`
Telephone Olt ,,
(516) 765-1801 '
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 199 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool X
PERMIT ISSUED TO:
NAME: Peter and Louise Lesica
ADDRESS: 770 Town Harbor Lane
Southold, New York 11971
DESCRIPTION OF PROPOSED CONSTRUCTION or ALTERATION
New Single Family Dwelling
APPROVED as per Suffolk County Health Dept. approval.
LOCATION OF PROPOSED CONSTRUCTION or ALTERATION:
OWNER OF PROPERTY: Peter and Louise Lesica
OWNER MAILING ADDRESS: 770 Town Harbor Lane
Southold, New York 11971
OWNER PROPERTY ADDRESS : Soundview Avenue
Southold, New York
TAX MAP NO. : Section 514 Block 6 Lot 16
CROSS STREET: Booth Street
BUILDING PERMIT NUMBER CROSS REFERENCE:
•
Judith T. Terr
Southold Town Clerk
DATE : July 9, 1987
(TOWN SEAL)
OFFICE OF THE TOWN CLERK (JO H/re
Town of Southold
t"4"4. Application No. 0705
Judith T. Terry, Town Clerk +�
Town Hall, 53095 Main Road j Construction
P. 0. Box 1179 Alteration
Southold, New York 11971 ,y,.
_�l i � ; • Residential
Telephone
(516) 765-1801 Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.4_
Fee $/a — 9/ %.
DATE9 1 9 5
APPLICANT NAME: (--)e-r 12 fi L. p tl s L s/ C` R
APPLICANT ADDRESS: 7 7 w Hi9 e i' 2 /9 ti e
oa.7/-{oLD /V, /l ) 7/
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
pIE14) DwELL:Ny
LOCATION MAP: Must be attached hereto before permit may be issued.
• LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: 7/ l- NJ L1)t4I S..
OWNER MAILING ADDRESS: 79Q TvwA) ,1g2b n2 LAtiE
Sa 7 o4. d N.�/. 119 q �
OWNER PROPERTY ADDRESS: _c am SO((,U (//E &, HUF.
TELEPHONE NUMBER OF CONTACT PERSON: `] ( S- 2 3 7
TAX MAP NO. : Section 1 Li Block Lot / �1
CROSS STREET: G 17TH
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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SUFFOLK CO. HEALTH DEPT. APPROVAL
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STATEMENT OF INTENT
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GREENPORT NEW YORK
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