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ELIZABETH A.NEVILLE t$h`Z co
y Town Hall, 53095 Main Road
TOWN CLERK ; P.O. Box 1179
y Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS % %
MARRIAGE OFFICER %
�1�'►� Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER : �0 ‘0�� Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER ���0
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1904 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : SCHEMBRI HOMES INC.
Address 1 : P. 0. 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 #R10-98-0093
Name Of Owner SCHEMBRI HOMES INC.
Mailing Address 1 P. 0. BOX 163
City St Zip WADING RIVER NY 11792
Property Address 1 AVENUE OF TREES
City St Zip SOUTHOLD N NY 11971
Tax Map No. section 88.00 block 6 lot 13.050
Cross Street WATER TERRACE
Building Permit Number Cross Reference:
Issue Date: 7/30/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE • � Gr*. Town Ha11, 53095 Main Road
TOWN CLERK P.O. Box 1179
y Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS 1.4, Pr,'� Fax (516) 765-1823
MARRIAGE OFFICER � y
RECORDS MANAGEMENT OFFICER : :0 a0�1I/ Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER : � 10.
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: July 17, 1998
Transmitted herewith is a copy of application No. 1979 for a Cesspool/
Septic Tank Construction Permit submitted by:
Schembri Homes
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 re9ommendations:
APPROVE
DISAPPROVE
Comments:
\66
S' nature
iCt
Dated
OFFICE OF THE TOWN CLERK 0',c)FFOLIre"_
TOWN OF SOUTHOLD �,''AO O.. Application No. I q-19
FI.I7ABETH A.NEVI].1,F,TOWN CLERK
P.O.BOX 1179 ;� Construction I�
SOUTHOLD,NEW YORK 11971 ; o T
Fit Alteration
Telephone O,j► �ir,i. $10.00 - Residential i .
(516) 765-1801 -—•61 7'1,,0' $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 -1//5/218
APPLICANT NAME: CSCI`'tbI *1/11,<_7
APPLICANT ADDRESS: 410 4,
( /,/.(ie - I-or /L 11-74 2--
SEPTIC
--
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATIONf�4-
taie..:
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRU TIO OR ALTER ION:
OWNER OF PROPERTY: _5( l]�
OWNER MAILING ADDRESS: y` O _ 4-,,,, -3 1"I K/( 7q.L
l
OWNER PROPERTY ADDRESS: C2 •
__4-Y-A=ctILL—J1,1
TELEPHONE NUMBER OF CONTACT PERSON: 901q10I
TAX MAP NO. : Section / DOD Block 046?) Lot OU/ I b.
CROSS STREET: 00, T?kY Ci(
BUILDING PERMIT NUMBER CROSS REFER NCE:
. /0„ 4;.."
ignature of Applicant
•
RECEIVED BY: P/.-
wn Clerk's Office
DATE: � /9
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