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ELIZABETH A.NEVILLE $�`Z`� Gym�` Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
Cl)• Z Southold, New York 11971
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REGISTRAR OF VITAL STATISTICS • Fax 47$ Fax (516) 765-1823
MARRIAGE OFFICER ‘‘.4*
=y*O! �� eig Telephone (516) 765-1800
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER ��'
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1872 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. REF #R10-98-0070
Name Of Owner POCILLICO CONSTRUCTION
Mailing Address 1
City St Zip 0000
Property Address 1 AUGUST LANE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 53.00 block 4 lot 44.002
Cross Street
Building Permit Number Cross Reference:
Issue Date: 6/03/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE i,�`Z� Gym; Town Hall, 53095 Main Road
TOWN CLERK y :-- % P.O. Box 1179
% 2 Southold, New York 11971
REGISTRAR OF VITAL STATISTICS O ��i Fax(516) 765-1823
MARRIAGE OFFICER �: y ����� Telephone (516) 765-1800
RECORDS MANAGEMENT OFFICER ` woo ��
FREEDOM OF INFORMATION OFFICER
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: May 28, 1998
Transmitted herewith is a copy of application No. 1946 for a Cesspool/
Septic Tank Construction Permit submitted by:
Schembri Homes Inc. for Pnrillico Construction
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:
APPROVE ✓
DISAPPROVE
Comments:
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OFFICE OFTHE TOWN CLERK ,11!I �FFO[ke _ ����
TOWN OF SOUTHOLD % 'c Ql/aitA Application No.
ELIZABETH A.NEVILLE,TOWN CLERK � 0
P.O.BOX 1179 : ;L Construction
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SOUTHOLD,NEW YORK 11971 i
VI rnyc Alteration
Telephone 0,�,�, Q�',' $10.00 - Residential
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(516) 765-1801 _ �l 4�,•1' $25.00 -Non-Residential
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TOWN
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATES 2 0-1
APPLICANT NAME: <J121, 47APPLICANT ADDRESS_ 1 0. (J3
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SEPTIC CESSPOOL l.---/-----
DESCRIPTION
./DESCRIPTION OF PROPOSE • CON TRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONST ' , CTION OR ALTERATION:
OWNER OF PROPERTY: Q'a I -
OWNER MAILING ADDRESS:
OWNER PROPERTY ADDRESS:
b- ' ?C l 3 W • I/ . .(. /r 7f-1- -
TELEPHONE NUMBER OF CONTACT PERSON: 9,,L_9 r77
TAX MAP NO. : Section J 3 Block 0/ Lot Yt 04-
CROSS STREET: /y
BUILDING PERMIT NUMBS CROSS REFERENCE:
2 /
4 , .
Signature of Applicant
RECEIVED BY:
T
DATE: �� �wn Clerk's Office
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SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
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ERNTSINGFOLLEAPrRlAMLALY ORSsFGO UCTIO
OlLYN FOR As�ub cfc: _t'ol`s
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/ DATEIMY t 7'II �'� *. v s• �, , 6 MAY 0 5 1998
FOR MAXIMUM OF BEDROOMSc3 EXPIRES _� _ _ _-
THREE YEARS FROM DATE OF APPROVAL
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XCAYAflON INSPE - i•N RQUIREO
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THE WATER SUP LY 8 SEWAGE ''''Z
DISPOSAL FOR HIS RESIDENCE
WILL CONFRO TO THE STAND- T L
ARDS OF THE SUFFOLK COUNTY (....0 7-LL
DEPT.OF HEALTH SERVICES. vez
at-Vitnc.4 i Ica - i Sum
Unauthorized alteration or addition to this document is a violation of Section 7209 SURVEY OF: 10'r'
of the New York State Education Law.
Certifications indicated hereon shall run only to the person for whom it is prepared
and on his behalf to the Title Company,Governmental Agency and Lending MA(eC:t G ' .
Institution listed hereon,and to the assignees of the lending institutions or subse-
quent
/
quent owners. ^�// 'L� /? c�/_,_
Copies of this document not bearing the professional's inked seal or embossed �F+J 11'1T (�( ��� �(�{/�
seal shall not be considered a valid true copy. //
The offsets(or dimensions)shown hereon from structures to the property lines are !/J� 1m', tvJ Y1tk
fora specific purpose and use and therefore are not intended to guide the erection of l `�
fences,retaining walls,pools,patios,planting areas,addition to buildings or any other
construction. s
The existence of right of ways and/or easements of record,if any,not shown are %% NE G ,
not guaranteed. ¢�`i O , .Y DATE: .414/2„ SCALE: 1 '' - 40 ,
y DESTIN G.GRAF
CERTIFIED ONLY TO:
G�4EvHgrt) --�ttrs� :NIT g: q' ,M ,,
DESTIN G. GRAF
)� LAND SURVEYOR
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By . •LIC• SE,io,f" I
DESTIN G.GRAF N.Y.S.LIC No.50067 O _ At 73 WOODLAWN N WN YORKROAO
ROCKY POINT,NEW 11778
TAX I.D.No. 1 Dop - �3 - o4 - qq,L Ory- PHONE(516)821-3442