HomeMy WebLinkAboutAdel, Werner (3) JUDITH T.TERRY �� Gyt Town Hall, 53095 Main Road
TOWN CLERK Z P.O. Box 1179
• �� Southold,New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER Fax (516)765-1823
RECORDS MANAGEMENT OFFICER �.� `�►a 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. 1532 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. #1110-96-78
Name Of Owner ADEL, WERNER AND CRON,DICK
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Mailing Address 1 P. O. BOX 163
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City
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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 8.031
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Cross Street FARM VEU ROAD
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Building Permit Number Cross Reference:
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Issue Date: 8/29/96Judith T. Terry
-------- Southold Town Clerk
(TOWN SEAL)
O��S�FFO��-coG
JUDITH T.TERRY =� 'yam Town Hall, 53095 Main Road
TOWN CLERK y P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Oy �� Southold,New York 11971
MARRIAGE OFFICER Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER ��( �a� Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
2 7 IaF
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: August 26, 1996
Transmitted herewith is a copy of application No. 1598 for a Cesspool/
Septic Tank Construction Permit submitted by:
Peter Schembri for Werner Adel and Dick 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.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVEy
DISAPPROVE
Comments: �C1 oo
Signatur
� c
Dat d
OFFICE OF THE TOWN CLERK
Town of Southold w
Judith T. Terry, Town Clerk Application No. / .5
Town ball, 53995Main Road Construction !�
P. O. Box 1179 Alteration
Southold, New York 11971
Telephone $10.oo -Residential
(516) 765-1801 $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PER*IT
SEPTIC TANK or CESSPOOL
Permit No.
Fee '$ n
DATE
APPLICANT NAME:
APPLICANT ADDRESS: < U (p
SEPTIC CESSPOOL,(,/
DESCRIPTION OF PROPOSED CONSTUCTIO OR ALTERAT N
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION Of PROPOSED CONSTRU TION OR ALTE.RATI N/,�
OWNER OF PROPERTY: W'„ 1'.
OWNER MAILING ADDRESS:
OWNER PROPERTY ADDRESS:. (/
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : SectionLk Block -3 Lot g 3
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE
Signature of App cant
F
RECEIVED BY:
Town Clerk's Office
DATE
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WATER SUPPLY SEWAGEDISPOSAL SYSTE114S MUST
A- . M CONFORM WITH W iTANDARDsDATED NOVEMBER 13,1995.
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' SUFFOLK CO.TAX MAP DESIGNATION;
DIST. SECT. BLOCK .
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