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JUDITH T.TERRY =� ?1 Town Hall, 53095 Main Road
TOWN CLERK ti = P.O. Box 1179
•
REGISTRAR OF VITAL STATISTICS � �� Southold, New York 11971
MARRIAGE OFFICER Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER ! `t►� 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. 1575 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : SCHEMBRI HOMES, INC.
Address 1 : P. O. BOX 163
City St Zip WADING RIVER NY 11792
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. SCHD REF. #1110-96-0103
Name Of Owner ADEL, WERNER AND CRON, DICK
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Mailing Address 1 C/O SCHEMBRI HOMES, INC.
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P. O. BOX 163
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City St Zip WADING RIVER NY 11792
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Property Address 1 HARVEST LANE
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City St Zip MATTITUCK NY 11952
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Tax Map No. section 120.00 block 3 lot 8.009
------ --- ------
Cross Street
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Building Permit Number Cross Reference:
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Issue Date: 11/26/96 Judith T. Terry
-------- Southold Town Clerk
(TOWN SEAL)
O �G
JUDITH T.TERRY =� ?1 Town Hall, 53095 Main Road
TOWN CLERK y Z P.O. Box 1179
REGISTRAR OF VITAL STATISTICS
V&-- • �� Southold, New York 11971
MARRIAGE OFFICER Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER ��l �a� Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department f
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: November 15, 1996
Transmitted herewith is a copy of application No. 1641 for a Cesspool/
Septic Tank Construction Permit submitted by:
Schembri Homes for Adel/Cron
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.
7
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE
DISAPPROVE
Comments:
RECEIVED
t �
NOV 2 51996 Signature
3 �L 65-1 `'
Southold Town Clerk at
OFFft.8 OF THE TOWN CLERK
0 Town of Southold Application �J
Judith T. Terry, Town Clerk �,L pp NO
Town Hall, 53095 Main Road Ln j Construction
P. O. Box 1179 ` Alteration r
Southold, New York 11971
Telephone01t ' 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.
Fee $ /'�
`DATE A /•f r7
APPLICANT NAME: 11.L
APPLICANT ADDRESS:
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONST UCTIOJ4 OR LTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY : � --- /
OWNER MAILING ADDRESS: 0 ( (3
OWNER PROPERTY ADDRESS: X4� %` �
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section Block 3 Lot
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of Applicant
RECEIVED BY: _
Town Clerk's Office
DATE:
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