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JUDITH T. TERRY � , Town Hall, 53095 Main Road
TOWN CLERKH P.O. Box 1179
REGISTRAR OF VITAL STATISTICS �,C�1 �� Southold, New York 11971
MARRIAGE OFFICER +N7 O �,��' Fax (516) 765-1823
� �®��4' 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. 793 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 11947
Descriptor of Proposed Construction or Alteration
NEW SINGLE FAMILY DWELLING WITH CESSPOOL SYSTEM.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICS ON 12/31/91 .
Name Of Owner MORCHEL, GISELA
Mailing Address 1 MAIN ROAD
City St Zip JAMESPORT NY 11947
Property Address 1 MAIN ROAD
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 109.00 block 2 lot 13.005
Cross Street CROWN LAND LANE
Building Permit Number Cross Reference:
Issue Date: 1/07/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL
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JUDITH T. TERRY ;v k. Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS , �'l Southold, New York 11971
MARRIAGE OFFICER N� ��` Fax (516) 765 1823
®�jy® �� ��! Telephone (516) 765-1801
OFFICE OF THE TOWN_CLERK ,14)''�� (,!,'.-?4 =7' LI \-7-3'' ' "
TOWN OF SOUTHOLD it ii ;1 i
DEC 3'
ilkTo: Southold Town Code Enforcement Officer f ;== ___,!L_-)
From: Linda Cooper, Southold Town Clerk's Office ��e � y---- ''µ'°_°f�w-�'
Dated: December 31, 1991
Transmitted herewith is a copy of application No. 814 for a Cesspool/
Septic Tank Construction Permit submitted by: RECEIVEfl
Liso Construction Corp. for Gisela Morchel
JAN 02 IPS)
Please review the application and location map and advise if the project
has received Suffolk County Health Department approval and if Ithilis GiniatitiOrd
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 X.
DISAPPROVE
Comments: 04, ,�,4,, (�- a{, n p F
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[ Signature
Dated t` 1\��
OFFICE OF THE TOWN CLERK ; �,,,'",,"'`'
Town of Southold -I'' C��FFULK`'. = �6
Judith T. Terry, Town Clerk ��'',% e ".. Application No. /
Town Hall;/ 53095 Main Road �� �0, = Construction 4 '
P. 0. Box 1179 , = { 7C
Southoli, New York 11971 _, r': Alteration /
Telephone _® - ®��' $10.00 - Residential �/
p _
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(516) 765-1801 J = 01 �, !' $25.00 - Non-Residential
-- ...001
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATED 31.2 loll, l
APPLICANT NAME: 1.--. \ 5 0 C.. 1 1--i 5 1 t' A P
APPLICANT ADDRESS: Fp 2,0 X L' 9
1 A-o--.Lea - t 1 -( i fa/ i
SEPTIC ZCESSPOOL l�
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
] 46 o i/- F/4-/-7, L. --/ pi-LL=/.� ,,.e/
LOCATION MAP: Must be attached hereto before permit may be issued. .
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: Cc, t S L. L A- 111. ®(a-c-ck- L
OWNER MAILING ADDRESS: '11 Ki N 0.. - S fa' tc P' ` . `1,-.0.`/
OWNER PROPERTY ADDRESS: fl is,c t`( pj t R 6,-1./ .LJa!-el0 Lh,
vT�c—Al� c•� /CZ_`-/ .
TELEPHONE NUMBER OF CONTACT PERSON: ?r�.2--(--f es-1
TAX MAP NO. : Section /0`, Block c72.. Lot /3. Z--.
CROSS STREET: (2_40,-14 L yd- r-t 6 L/45- •
BUILDING PERMIT NUMBER CROSS REFERENCE:
a
c---- '‘e.9,- ' IV - . PA—,---a____
Signature of Ap licant
RECEIVED BY: 5) tibi(--e4-(„1,_
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Clerk's
DATE: - /2.-.A (( 7
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y. . , 1', , • ' SUFFOLK CO HEALTA DEPT.APPROVAL ,
'\ ' j H S NO.
tg;+, t•.;• :.: ', ; MAP OF PROPERTY :WELL COVENANT REQUIRED. ..
I ',— ,; I,,- PRIOR TO
TP SURVEYED FC1R FINAL APPF40V�L.
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+ (RES.) 1 { — STATEMENT OF INTENT
1 AT-
, THE WATER SUPPLY AND SEWAGE DISPOSAL
/WELL r �+ rC G SYSTEMS FOR THIS RESIDENCE WILL
• . - - • yo _4JT �..al.
TG`rJN OF SJJTHO_'D' N.Y. CONFORM TO THE STANDARDS OF THE , .
�~ SUFFOL C DEPT HEALTH SERVICE
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tRcS.) o y \ PCW. T({KKL. i /`� y+ I f� JAM ESPC2T,NY 11047
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