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JUDITH T.TERRY t,�� Gym\� Town Hall, 53095 Main Road
TOWN CLERK y 2 P.O. Box 1179
v Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
#,* Fax (516) 765-1823
MARRIAGE OFFICERO 1
RECORDS MANAGEMENT OFFICER : 0l' '�� �� Fax
(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. 1727 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 #R10-97-0130
Name Of Owner SCHEMBRI HOMES INC.
Mailing Address 1 P. O. BOX 163
City St Zip WADING RIVER NY 11792
Property Address 1 KERWIN BLVD.
City St Zip GREENPORT NY 11944
Tax Map No. section 53.00 block 4 lot 44.033
Cross Street AUGUST LANE
Building Permit Number Cross Reference:
Issue Date: 9/10/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
/ 77
•
' OFF°tir
JUDITH T.TERRY = yid `� Town Hall, 53095 Main Road
TOWN CLERK y P.O. Box 1179
rIr ; Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER `�y ��, Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER =.0.( `1,-; Fax
(516) 765-1800
FREEDOM OF INFORMATION OFFICER •• .00-1,
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: September 5, 1997
Transmitted herewith is a copy of application No. 1799 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
* * *
*1
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE ✓
DISAPPROVE
Comments:
4na ttiuie
Dated
OFFICE OF THE TOWN CLERK "
Town of Southold . ' ica f eLL
Application No./7 9'P
Judith. T. Terry, Town Clerk -`;
Town Hall, 53095 Main Road Construction 4'
P. O. Box 1179
Southold, New York 11971 Ariz Alteration
Telephone = � r $10.00 - Residential
(516) 765-1801 :"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 $ Vs—
DATE
17
APPLICANT NAME: 411"---)" A-1"<
APPLICANT ADDRESS: /0- // ( 3
Wi /I - i/t/F /129i
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATIONefa4t4-4
% G'
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION A TERAT ION
OWNER OF PROPERTY:
OWNER MAILING ADDRESS: •- ( Co 3 W ` rV /
( 7
OWNER PROPERTY ADDRESS: J/ oji v-t
e 0A44.,-ev\ztlA"L CtArAlsge-N. 'W
TELEPHONE NUMBER OF CONTACT PERSON: 9,29
TAX MAP NO. : Section 5- 3 Block OK Lot /1(3 3
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENC :
f
Si•na ure of Applicant
RECEIVED BY: /4c1 )44
Town Clerk's Office
DATE: 0797'
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SUFFOLK C.OI/NTy DEPARTMENT HEALTH SERVICES
PERMIT FOR APPROVAL t7r,CON
STRUCT
3INCLE PAMIL RESIDENCE ONLY N FOR A
DATEAn 9 ,' 1�
t :191: ‘i151,
REF , ,r -97 - rr �l Jl� t — /
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RES iNREE YRA RS FROM DATE.O A:PR�r�,
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THE WATER SUPPLY&SEWAGE -° 1 ,-'(' `' (io-r P. ../A-c.-
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DISPOSAL FOR THIS RESIDENCE
WILL CON FROM TO THE STAND-
ARDS OF THE SUFFOLK COUNTY
DEPT.OF HEALTH SERVICES. EXCAVATION INSPECTION REQUIRED
Received
Suffolk County
4°t 144:,`4 AUG19 1997
(,01 (4 istmv.mcGi dATvm, , _
Unauthorized alteration or addition b this doautliePta t tsi 6108the New York state Education Law. 1kM tYtt. SURVEY OF: 1..._0-r 3
a was
Grltficatiaa iridkgtted hereon shall rex,only to�4arwh�repar.d /,,��,/ o� �'uG�iT �� �-z'�io�► t
and on^4.ehalt b der rid Company,Genzoi"nriaindt ,and lending
institution Nsted hereon,and a tiie assignees a the diirntgy institutans or subse-
Quent owners. r4 4 .1-r1ek W I o wig!Q vl �w
Copies a this dotxKriern not bearing the professional's inked seal or embossed � /O,� �
seal shall not be considered a valid true copy. ��'FWW��
The offsets(or dinunsions)shown hereon from structures to the properly lines are `�!/ ,
for a specific purpose and use and therefore are not intended to guide the erection of V E f
tans,retaining waas.pools.para ,plantingto or
Patios. areas,additionbuildingsany other i
g
construction. ,OF NEW j„
The existence of right of ways and/or easements a record,if any,not shown ar 'S i• /
not guaranteed. .rP S '41*ATE:
SATE: 3141 SCALE: 1 it: fp
DC071) 0.GRAS
CERTIFIED ONLY TO: ••'- DESTIN G. GRAF
L • t s., - lar- . 5111
y" ",: LAND SURVEYOR
,r 4s
.. �. LIC' 9E#
By V Ole,0 , 73 WOODLAWN ROAD
DESTIN G.GRAF N.Y.S.LIC No.50067 �, . ROCKY POINT,NEW YORK 11778 O
I TAX I.D.No. 000 . s?J - 04 - 44, 3 3 PHONE(516)821.3442