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JUDITH T.TERRY i,_ y��`` Town Hall, 53095 Main Road
TOWN CLERK ; y 1 Ik P.O. Box 1179
2 Southold, New York 11971
REGISTRAR OF VITAL STATISTICS O 41$
Fax (516) 765-1823
MARRIAGE OFFICER `�=yifRECORDS MANAGEMENT OFFICER O �Q�'��� Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER 1- ,����'
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1673 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.
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 5.000
Cross Street HOMESTEAD DRIVE
Building Permit Number Cross Reference:
Issue Date: 5/15/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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Town Hall, 53095 Main Road
y0 0�� P.O. Box 1179
1D , Southold, New York 11971
JUDITH T.TERRY TELEPHONE
TOWN CLERK (516765-184111
REGISTRAR OF VITAL STATISTICS
OFFICE OF THE TOWN CLERK •- E 1
TOWN OF SOUTHOLD
8 -7
TO: Southold Town Building Department
FROM Linda J. Cooper, Southold Town Clerk's Office
DA`1'ED: May 7, 1997
Transmitted herewith is a copy of application No. 1743 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 recd omndations:
APPROVE
DISAPPROVE
• Comments:
RECEIVED
MAY 1 1997 'gnatur
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SOLithOffi.v Ciet
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OFFICE OF THE TOWN CLERK ",,,,,
•
Town of Southold Ffil{K
C Application No. /71/-*
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road .4= Construction Z-----
P.
P. O. Box 1179 p ` Alteration
Southold, New York 11971 $
Telephone Vi ��,� $10.00 - Residential (-/
(516) 65-1801 -y�1 i �,►I'‘' $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
C� DATE s/1/77
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APPLICANT NAME: (�
APPLICANT ADDRESS: /d./kojia7�
(-/\-) 6-1-4---j A)-- vv,( i -// 7 9 -.
2; ji,f7,5 ,,_,
SEPTIC CESSPOOL ___
DESCRIPTION F PROP SED ONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTR Tlpp N O ALTERATION: (
OWNER OF PROPERTY: C`���'L l C sh
`
OWNER MAILING ADDRESS: 5 -e___
OWNER PROPERTY ADDRESS: L6 /.2- 01(..
}4-uze-ris-d- loll(-.
TELEPHONE NUMBER OF CONTACT PERSON: S / ‘ 7°2 - /I4'
TAX MAP NO. : Section 3 ) Block 0c" Lot
CROSS STREET:
,w
BUILDING PERMIT NUMBER CROSS REFERENCE:
17
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Signature of Applicant
RECEIVED BY: Al/
Town Clerk's fice
DATE: 371/97
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