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OFFICE OF THE TOWN CLERK OFO(/r`,"
Town of Southold ,
Judith T. Terry, Town Clerk ,r:- •.y
Town Hall, 53095 Main Road 8
P. 0. Box 1179 ♦to Y: , •
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Southold, New York 11971 Oe•�,
Telephone , ,,
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 182 Residential - X
Non--Residential
Fee $ 10.00
Septic Cesspool x
PERMIT ISSUED TO:
NAME: Liso Construction Corp.
ADDRESS: Herricks Lane, P.O. Box 439
Jamesport, New York 11947
DESCRIPTION OF PROPOSED CONSTRUCTION or ALTERATION -
New Single Family Dwelling with Sanitary System
APPROVED as per Suffolk County Health Dept.
LOCATION OF PROPOSED CONSTRUCTION or ALTERATION:
OWNER OF PROPERTY: Susan Lee and M. Lee Phelan
OWNER MAILING ADDRESS: 250 Korn Road •
Southold,, New York 11971
OWNER PROPERTY ADDRESS : Reydon Drive
Southold, New York
TAX MAP NO. : Section: 79 Block 5 Lot 14.3
CROSS STREET: North Bayview Road
BUILDING PERMIT NUMBER CROSS REFERENCE:
avri-f4e4°'.
Judith T..-Ter
Southold Town Clerk
•
DATE: June 10, 1987
(TOWN SEAL) '%'
•.S ...��
OFFICE OF THE TOWN CLERK c,§\FFUL4C
moi/
JudithTown of
thold
T. Terryy,, Town Clerk � .. D�
: Application No./o 52
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Town Hall, 53095 Main Road ':. - Construction
P. O. Box 1179
*' 4 — Alteration
Southold, New York 11971 }' ®�-�;
Telephone 6:i 11# �. Residential
(516) 765-1801 " ' Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. /(J
Fee $,JQ
DATE •..)v �G 1q C- '7. _
APPLICANT NAME: L1 s43 0 P ? ,
APPLICANT ADDRESS: 14 as A crt. Lc,,- Pp [3c' q
/4-1--1, po rz Iia/. 1 IQ'V 7
SEPTIC ;-/ CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
t, a -Eta L'--f L
5E($T d - .a eG..s s Pe,40
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: Ste' (;, Irl e �+ r�� �'l . �. 4)1
OWNER MAILING ADDRESS: ,��t� Q.O>,
OWNER PROPERTY ADDRESS: P, ..*Do ,i-) v E=
t2 Lor L7r." 14-"/ 5
TELEPHONE NUMBER OF CONTACT PERSON:
/6f® ,/
TAX MAP NO. : Section a 7 Block ®.- Lot /14,._3
CROSS STREET: /Voi3.1 I-1 / /4-4-1.V t _- R D .
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature"of Applicant
RECEIVED BY: 4RilLAL. !c-AP
Town Cl/ k's Offi fe
DATE:
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�iRADE EL._46/f
'IIl 1.8 J r BROWN LOAN
�5 1� � ��� T SER�IICES 25
I BROWNSANDYLOAM
4itim.,
/' �01SNn DEpARTNiEiT OF 1��,.L
r_
SUFFOt-K (` (� 1 ,
CR ^,.�c,Tr UGflO�• REDO/SN BROWN M d P OF
0� . PPRP"'I- DF U�� .. COARSE/VERY OARSE
' i •7 �j i;l�l ��V� ' SANDS ,
sir. FOR A
(NEW) 143 rs�nb`� F�';'`` ""`u�� �V g�S� DESCRIBED PROPER T r
�� 13 � i Ar
2 F<<` \® B C MON DATE A N r
A NO NA7ER /1 t
asJ�oysr �'`\ DR�'�`ED�-"� F AppR0\'AL TEST HOLE DATA B A Y v I L W
R°je O"' \. T S - O ‘1E.-"*-3
y1"-J - IBJ'\•, A TE a - TOWN OF S O U THOL D
/� ¢e • mss. SUFFOLK CO, N Y � =-� ��
o . N \\ ' ' P i i • ,4X t!@T
.e,e)3ft .
00--f1/
WELL/ 'Q/
RC r \ 5y7, \ \ \
o� ES•' wELc , •;
R AK Ai •r moo,.\ \ y c y�,y� 141154 :
E R x�3 ' Q��+ 1'` `
�, F
No `` r SC
O b ct
I am familiar eith the Standards fofo ,4�o�r nal and `\ 3- • y��T/1 Op
onstructioeof Elilbsurfac Sewage Disootj- stems L T" CERT/F/ED TO. viCF�
6l Y 4 +6/r •/ _ \ o
.,for le ' a. : y Residences and will abide by if= ia'c — o•4o ; - CH/CA60 TITLE INSURANCE .CO
condition. ,rforth therein and on the permit to 1, - T/TEEN' 8408- 06257
Aolistru . 4,6:9 .- -48.5 - �`
;t= yto,}pe. "' ;'.L�.--.% w .s c -/ CO 4 .f �- -- .,•o/ FOR
R
Signet re ��'.,,,L ; >�" ``�— a°-• Q \O �• '4'�! SUSAN LEE PHEL AN'8
` M.L EE PHEL A NA cPt * 0,S "4.-.•
4/
qF = 'O' .:tiQ _ \
< $of 0 5 T2s, 1 -I::: 0
y�.4„r.,- �� . sealon-a surveying &
AREA: 53,744sq.ft. RES �, / x a �'. o� ,Q`' engln:?ering pc.
-
a2338 acres) i 9js seE� ` ::;� . ka 40 west main street
°'pT. ,• • ". ' V . riverheadLnew yo; k 11901
NOTE.' MAP OF LOT 3 SUBDIVISON N as.�
FOR GEORGE 8 OPAL 84 jr-,.. -�4<<o °j6* (516) 369 I t l 7
�tVA�'/nNS 4Rt IN
A/(SC/N AT BAYV/EW TOWN OFSOUTHOLD vF, h,• , ASSUM4rD DATUM Feb. 4, 1985 Job. N285-755
APPROVED BY PLANNING BOARD JULY i8, /977 'PO. �,/ $0 /
NOV 29,/986 1000-079-05-14.3 Scale: I = 60'
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