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ELIZABETH A. NEVILLE ?` Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
Southold New York 11971
REGISTRAR,OF VITAL STATISTICS a ' '
MARRIAGE OFFICER `� wk x,, , Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER =__ ®� II:,,� /// Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER /' / southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2726 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : LISO CONSTRUCTION CORP
Address 1 : PO BOX 439, 921 MAIN ROAD
City St Zip SOUTHOLD NY 11971
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. REF #R10-01-0225
Name Of Owner BLASKOVIC, OLGA E NEVIO
Mailing Address 1 1118 HOWARD DRIVE
City St Zip WESTBURY NY 11510
Property Address 1 WILLOW POINT ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 56.00 block 5 lot 29.000
Cross Street BAY HOME ROAD
Building Permit Number Cross Reference:
Issue Date: 1/11/02 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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#,,,,,,,-_____-- o717
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_ ELIZABETH A.NEVILLE /a Wyk: Town Hall, 53095 Main Road
TOWN CLERK y P.O. Box 1179
REGISTRAR,OF VITAL STATISTICS
% v, Southold, New York 11971
MARRIAGE OFFICER ®1i A.tee Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER =__�®1 Ali ����i� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER r��� southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD OPif � �2 �' y�7 �
i , I� l� `gyp ; i
TO: Southold Town Building Department ;W`' uEC 2 2001 ,; ,
FROM: Linda J. Cooper, Southold Town Clerk's Office ',
DATED: December 20, 2001 Ce.
a
Transmitted herewith is a copy of application No. 4005 for a Cesspool/Septic Tank Construction
Permit submitted by:
Liso Construction Corp.
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.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and to tion map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments: �' — - -_ L--
.• 1124 - .
7
_
Signature
7
Dated
OFFICE OF THE TOWN CLERK ��,,,,,,,,,•-
-Town of Southold �,O �FFD(ke'
Judith T. Terry, Town Clerk �' 0
Town Hall, 53095 Main Road G Application No.
P. O. Box 1179 ; Construction
ca. ryi
Southold, New York 11971 %VS Alteration
Telephone 40° ,®"/4°� $10.00 - Residential l�
(516) 765-1801 -e4„,l
$25.00 - Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
RECEIVED
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL DEC 2 0 2001
urhogo Town Clerk
Permit No.
Fee $
DATE 1 ,X ( C? t3
APPLICANT NAME: 1.0 S 6 _ Q .S-s • v RP
APPLICANT ADDRESS: qa.. l 4 f( I14 po E3to1 4�'
V.-CESSPOOL „‘ n.�+�.� P® i -l �( I ( A. (47,
SEPTIC ✓ CESSPOOL
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: OL-e... q Us- (`4 V d 3 L•+ S
OWNER MAILING ADDRESS: /f jg lite .4--42-4-b P' -'E
OWNER PROPERTY ADDRESS: - 1,f_Co 14-4.4 F2.1
L (,''//� p/ lam ,y •
TELEPHONE NUMBER OF CONTACT/ PERSON: L_� a p,%( Lc S O Z)..).
TAX MAP NO. : Section �C� Block OS—
Lot oZ
CROSS STREET: 13 ' '' ( )40' i4-%- -t
BUILDING PERMIT NUMBER CROSS REFERENCE:
/-
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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PERMIT FOR APP' •VALOFCONSTRUCTIORFOR / s 'Y F' +
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SINGLE FAM Y RESIDENCE ONLY •. . ' \ '
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DATEta1151��H.' R. ii. 14 �� ��'Z� %• rpQ
APPROVED ,�...`.�limp. •
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EXPIRES THREE YEARS FROM DATE 6 F ;,.' t VVAL o -• c r ti
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