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Off'
Co.
JUDITH T.TERRY 3 Town Hall, 53095 Main Road
TOWN CLERK ` N ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS O � Southold,New York 11971
MARRIAGE OFFICER �y �.�'°�' Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER = 0.( `1►�001Fax
(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. 1700 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. #R10-97-0044
Name Of Owner SCHEMBRI HOMES INC.
Mailing Address 1 P. O. BOX 163
City St Zip WADING RIVER NY 11792
Property Address 1 WILLOW DRIVE
City St Zip GREENPORT NY 11944
Tax Map No. section 33.00 block 6 lot 1 .000
Cross Street WESTWOOD LANE
Building Permit Number Cross Reference:
Issue Date: 7/14/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
706
el°oFFOL,'C
JUDITH T.TERRY � _ G'y�► Town Hall, 53095 Main Road
TOWN CLERK • o • P. O. Box 1179
• W Southold, New York 11971
REGISTRAR OF VITAL STATISTICS Fax (516) 765-1823
MARRIAGE OFFICER �w 11
RECORDS MANAGEMENT OFFICER = �( Jig 116O 111 Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER �o�•" _11111P �
OFFICE OF THE TOWN CLERK [ R 0 M
TOWN OF SOUTHOLD L5 U l5
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Offi.- '
DATED: July 9, 1997
TOWEPT
BLDG.OSOUTHOLD
Transmitted herewith is a copy of application No. 1770 for a Cesspool/
Septic Tank Construction Permit submitted by:
Schembri Homes Inc.
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:
JigCILA"-3 C 1. �s-••-c�a�_ -
nature
Dated
OFFICE OF THE TOWN CLERK """-
Town of Sputhold 0,14f Utk
Judith T. Terry,
Town Clerk ��. Application No. /—/?O
Town Hall, 53095 Main Road ,114 - Construction
P. O. Bbx 1179 Pf+ Alteration
Southold, New York 11971
Telephone ,� kr�' $10.00 - Residential
(516) 765-1801 4�1 '
'
- �� � $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 f
APPLICANT NAME: Hrri"—?4 -
APPLICANT ADDRESS: ( 3
f-2-
SEPTIC CESSPOOL L�
DESCRIPTION OF PROPOSED CONSTRUCTIR TERATION y
U% •
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY:
OWNER MAILING ADDRESS:
OWNER PROPERTY ADDRESS: _
1 L O t e ) {DRi. 0 F.. �'o P p drDL
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section 3 Block Co Lot
CROSS STREET: Widefrif
BUILDING PERMIT NUMBER CROSS REFERENCE:
Art/ /
1 / -
Signature of Applicant
RECEIVED BY: _
own C erk's Office--
DATE:
fficeDATE: —RECEIVED----------
JUL__. 91997
Soidfiold Town Clot*
It' —
7 e r r'R l' IMPARTMENT OF HBALTN
SI1RVICES
W E S T W O O D . P6RMlT PORI APERIC VAL O com'i'RUcnot4 FOR A
LANEFAMIFAMILYONLY
DATE .� z S /4 .
l� .~ / 1 ... 7 ,Qc>V t,
APPROVED , of �l z-7 r.(,l/? 1....
Z
OFOR MAX yilAtQE., EDRooms_---- --.....-
k EXPIRES
EXPIRES THREE YEARS FROM DATE OF APPROVAL
W ► ►i r, a 3 >>,.z
`J /(4.1 (PRIVATE ROAD) y
—
n 502'17'10"W 125.00' wT
�-- --___ V {4.a I 1 ,�,L
953.51'
Iv
LOT 8 fir.
o / o
O NI
_ — Pvor' 3 htalGt� •a N
/o J
. 1✓ 15 r7 t_
0) &A r2• 14.v �J
2 : ' ATION INSPECTION REBUIR
N1Li
N
(7.'' e: .i 1) /ti/7) k' />>/� ' 2
I THE WATER SUPPLY&SEWAGE <L 0,( 35 I - f
i
DISPOSAL FOR THIS RESIDENCE )G,,,;, / r1 5 >4 7.,
WILL CO'f
"I''..'...747.TO .i,[1.i40- /" :i /
ARDS 0i-"s"i ; .."'l1 ;-C.;i_F.COUNTY
DEPT.OF HEALTH SERVICES. ."-14-.' 1 .o
NO2'17'10"E 125.00'
Esir;. :! ';t.!. 1'f 11 :PT. OF
I{{ rt N/F MORRISON
• ') ' .i't t."_t 4 7
1
UnmdMired @RNntin or addition to fhb document is a vlotpUen of Section 7709
nl Ihn N. Y.s Slain Mutation torSURVEY OF: LOT 8
C..Iilk.dions irefantsd hereon shrill ran only In its.p.Don ler else...11 Io p.epaed
and on Ns behalf to ant Dale Company.Opremmentol Agency 01011-0.1109 .
institution bhereon..non,anal to intnpm
ees of the t«einq Mterdiom a nabs.- MAP OF HOMESTEAD ACRES
p.renl een.r,
Copies of this document not baring IM professional's Wad seal or embeseed //�}y
seal shall not be comb/aid a enid Inn copy. 'lee, l 1 —1-1,1.44 OF " //I,
T
the offsets in,dimrmims)sheen hymen Iran stnrllem to the properly lams ore
h' o specific I.M0 ando le,t and therefore ore not intended to pude the any le of � O rA' f V )�� _ /C��
tsetse,.elnini.q.MIs,pent,pMioe,Planting areas.e.IdNien to beidrnye a ay other .t ` 's A:0 t=— N Y
construction
existence of right of mays and/or easements of record.Nom/,red Mr0e'0 me lg.�/r�' ' � t •`fit 40'
not qumrmteed. G? /Dr.V,,:r.. r ort 11- DATE: 7..1 11 117 6r,,'y�t$ °,C,r; ..�..,.,. Y
CERTIFIED ONLY T0: � �'' � ; a
/�//t=1�EWlFjiCl mac? .tet - him i DESTI ilvRAF
t. LAND ' lt :YOR c ,'�,
a
cam.
A. v:*40,
By
DESTIN G. GRAF N.Y.S. LIC No. 50067 ' 8S1' 1 A v 1 :o.0 �' 1� `i
TAX I.D. No. 1000-33-6-1 . NONE nt-