HomeMy WebLinkAboutSchembri Homes Inc (25) /0,�f S�FFO( coO
JUDITH T.TERRY Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS % l.! Fax(516) 765-1823
MARRIAGE OFFICER 44.
RECORDS MANAGEMENT OFFICER 6.( `1►a ,lTelephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER 'v ,•�1��,'
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1734 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 #R10-97-0125
Name Of Owner SCHEMBRI HOMES INC.
Mailing Address 1 P. O. BOX 163
City St Zip WADING RIVER NY 11792
Property Address 1 GLENN ROAD
City St Zip SOUTHOLD N NY 11971
Tax Map No. section 78.00 block 1 lot 30.000
Cross Street GRISSOM LANE
Building Permit Number Cross Reference:
Issue Date: 9/24/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
17 � ((
JUDITH T.TERRY Town Hall, 53095 Main Road
TOWN CLERK ; y •
P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ` O Ill $ Southold, New York 11971
MARRIAGE OFFICER Fax(516) 765-1823
� � �/
RECORDS MANAGEMENT OFFICER .( `�►a 1O Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER , ••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 22, 1997
Transmitted herewith is a copy of application No. 1807 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 rreecoo endations:
APPROVE ✓
DISAPPROVE
Comments:
S ature
•
Dated
OFFICE, OF THE TOWN CLERK ,,''',,,,,-
Town of Southold .'��, �FF��K`'.
Judith T. Terey, Town Clerk , � crt Application No. /807
Town Hall, 53095 Main Road ; Construction
•
P. O. Box 1179 c ac
r Alteration
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Southold, New York 11971 y � /-- -
Telephone ��' $10.00 - Residential
(516) 765-1801 =y , $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 a 'L /r 7
APPLICANT NAME:
APPLICANT ADDRESS: 0.. A6 '
SEPTIC CESSPOOL (�
DESCRIPTION OF P OPOSED% ONSTUCTION ALTERATION
OfR,
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: GLe n _
TELEPHONE NUMBER OF CONTACT PERSON: 9cpci
TAX MAP NO. : Section - ' Block 0 ( Lot 0..
CROSS STREET: C9A/litt-
BUILDING
PERMIT NUMBER CROSS REFERE CE:
/ 7 ,
Signature of Applicant
RECEIVED BY :
Ierk's Office
DATE: • f_own
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