HomeMy WebLinkAboutAdel, Werner gAf F04coG
JUDITH T.TERRYo� Town Hall, 53095 Main Road
TOWN CLERK ti P.O. Box 1179
W_ T Southold, New York 11971
REGISTRAR OF VITAL STATISTICS • Fax(516) 765-1823
�RECORDSMANAGEMENT OFFICER y�0.� `j►�O� Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1530 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : PETER SCHEMBRI
Address 1 : P. O. BOX 163
City St Zip WADING RIVER NY 11792
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR NEW SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. SCHD REF. #1110-90-73
Name Of Owner ADEL, WERNER
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Mailing Address 1 76 OVERLOND DRIVE
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City
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City St Zip WADING RIVER NY 11792
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Property Address 1 FARMVEU ROAD
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City St Zip MATTITUCK NY 11952
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Tax Map No. section 121 .00 block 7 lot 2.000
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Cross Street HARVEST LANE
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Building Permit Number Cross Reference:
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Issue Date: 8/27/96Judith T. Terry
-------- Southold Town Clerk
(TOWN SEAL)
G
JUDITH T.TERRY =� 'yam Town Hall, 53095 Main Road
TOWN CLERK y P.O. Box 1179
REGISTRAR OF VITAL STATISTICSOy �� Southold, New York 11971
MARRIAGE OFFICER
Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER .( ��� Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: August 22, 1996
Transmitted herewith is a copy of application No. 1596 for a Cesspool(
Septic Tank Construction Permit submitted by:
Peter Schembri for Werner Adel
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 r commendations:
APPROVE
DISAPPROVE
Comments: JrkjA /o, ZI— Z9
Si nat e
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OFFICE OF THE TOWN CLERK
Town of Southold �j�FF��K`+O Application No/SIS('
Judith T. Terry, Town Clerk G
Town Hall, 53095 Main Road 1-.. Construction
P. O. Box 1179 v rZirn Alteration
Southold, New York 11971 � �
$10.00 - Residential
Telephone
(516) 765-1801 ! lxt $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE
APPLICANT NAME:
S
APPLICANT ADDRESS:
SEPTIC CESSPOOL
DESCRIPTION PF PROPOSED ONSTRUCTI ORALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCT ON OR ALTERATIO
OWNER OF PROPERTY:— ��
OWNER MAILING ADDRESS:
OWNER PROPERTY ADDRESS: EgkM VEE.,- .
r 7u c«
TELEPHONE NUMBER OF CONTACT PERSON:Aw
TAX MAP NO. : Sectio Block -7 Lot
CROSS STREET: lA_ ���
BUILDING PERMIT NUMBER CROSS REFERENCE:
ignature of Applicant
RECEIVED BY:
Tow CI rk's Office
DATE:
O SUFFOLK CO. HEALTH DEPT. APPROVAL;'A"
r N H. S. NO.
-7)
I15 _ 50 ---- n.A VAC. m i
STATEMENT OF INTENT
• � �0
N.-74717'00*E. 316 Z6 '` !
THE WATER SUPPLY AND SEWAGE DISPOSAL,
ApeS — - -- - - — r j SYSTEMS FOR THIS RESIDENCE -WILL:'
\l \�i �_� a_ j'r CONFORM TO THE STANDARDS. OF Ttie;'
^� Uw ,•._ qro- b N SUFFOLK CO. DEPT. OF
� _ � HEALT
H SERVICES
milS!d z�� 7 a u
APPLICAMT
C
SUFFOLK COUNTY DEPT, OF `HEAL
{ r SEPTtG E SERVICES - FOR APPROVAL F"Q
rte:_ PCOF. U1
-
1�. r
RaisE i �,a��`- 0 �► r CONSTRUCTION ONLY
• � DATE:
H. S. REF. NO..
- - - - -r tT- ➢ ` r APPROVED:
D2�vE
;..�[ ; -- r- Sc,
I r - 1vn flr' , SUFFOLK CO. TAX MAP DESIGNATION.
/' 1 DIST. SECT. BLOCK PCL.
' S7C 17'CC
;` 1 SCALE 55=!" K= 121 -r 2
• r '.26?4 ` OWNERS ADDRESS:
AQEA. ��ppHEAL't�iSilltYtCBS � -� � SAF.
Sc1MI K CMWrV DBRAtt P1011631.
I
w ott•tG RstiEaLt ,Y. 1(?9
J"MW FM XFMOV►L opco�uC M MR A LEASE. �fE
PAULY UMZNCX ONLY
tween well 1 G
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•
AUG 3 � ) t� Si=► 154 - ---._
DEED: L. N/A P.
{ Vt NOTE: LOT INJUM13E12� rZEFES2 Tp 1 TEST HOLE I 'STAMP
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MAP' OF PRO P PITY �
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IIA-AP AMEN PED-NAME C 4AN G E- ,Z,1�G i i to the asaignees of th°lending+>e6
j E.4 tution.Guarantees are not trensler3b�3
""T,^"f� ' � i to admional insiftwons orsu6se�
�t tj-._c' i • t '-1" L r. �• —SEAL
MAPPED .lt N2,1
>1 SLY AND SEWAGE DEPOSAL SYSTEMS MUST' -- u o
y .!�C'' r •:: tit�1."TR NEW S TANDAADS DA'TZD NOVEMm 13 1"S. RODE Rt{ K VAN
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LICENSED LAND SURVE LS
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ILfVI"POST :113 7
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