HomeMy WebLinkAboutSchembri Homes Inc (31) �,"ifC FFOc
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JUDITH T.TERRY � � yet 1 Town Hall, 53095 Main Road
TOWN CLERK % y i P.O. Box 1179
1 v' n'► 1 Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER �1�/ Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER %. Ol Il '`�►����� Telephone(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. 1770 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : SCHEMBRI HOMES INC.
Address 1 : P. O. BOX 165
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 #R10-97-0156
Name Of Owner SCHEMBRI HOMES INC.
Mailing Address 1 P. O. BOX 165
City St Zip WADING RIVER NY 11792
Property Address 1 HARVEST LANE
City St Zip MATTITUCK NY 11952
Tax Map No. section 120.00 block 3 lot 8.013
Cross Street FARM VEU ROAD
Building Permit Number Cross Reference:
„Ip C 4 e
Issue Date: 11/111/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY �
%�� y< Town Hall, 53095 Main Road
TOWN CLERK t y i P.O. Box 1179
1, Southold, New York 11971
REGISTRAR OF VITAL STATISTICS O .,�
MARRIAGE OFFICER `�y 0� / 1 (,, r F c -x823
RECORDS MANAGEMENT OFFICER ; °! * ' •a ' J f ----��e_ •1 70-1800
FREEDOM OF INFORMATION OFFICER ,•���i f E
} 1997 `b
OFFICE OF THE TOWN CLERI$ BLDG.DEPT.
TOWN OF SOUTHOLD ` TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: November 10, 1997
Transmitted herewith is a copy of application No. 1844 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.
14(4-d-z--
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following reco mendations:
APPROVE
DISAPPROVE
Comments:
ignature
it (I4 (q ---?
Dated
OFFICE OF THE TOWN .CLERK ,,,'"","'
Town of Southold l Ljc f
Judith T. Terry, Town Clerk Application No.___i •
Town Hall, 53095 Main Road Construction
P. O. Box 1179
Alteration
Southold, New York 11971 4W;' /
Telephone ��D���' $10.00 -Residential c/ _
(516) 765-1801 - 1
$25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCT ION or ALTERAT ION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $ _
DATE (//7 7
APPLICANT .NAME: 1 0
APPLICANT ADDRESS: ��
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTR CTION OR TERATION
i
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY:
OWNER MAILING ADDRESS: I /4.412„ce
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OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: ��Q_ J f
TAX MAP NO. : Section Block ° > Lot 4^/ `W
CROSS STREET: I v.4.4 VA- er,e
BUILDING PERMIT NUMBER CROSS REFERENCE:
gnature of Applicant
RECEIVED BY: irE1VEP
own C erk's Office
DATE: �OV- 10 1997
Southold Town Clerk
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SUFFOLK COUNTY DBP: : r.,t=-hi _ r.••a - • 'VICES
PERMIT FOR APPROVAL OF CacrinucrioN PCP?. A
THE WATER SUPPLY&SEWAGE :h a FAMIL;V iturasna,ONLY y--
DISPOSAL FOR THIS RESt bO i - (1 7 Received
WILL CO`�FROM TO THE STA .
AO�sD .• OCT 2 2 1997
ARDS OF THE SUFFOLK OOUNTY
POR MAXIMUMt. OfHealth ServiceOF7TJEflRO)MS f
DEPT.OF HEALTH SERVISES. Of Was!ewat r gmt.
EXPIRES THREE YEARS FROM GATE OF APPROVAL
Unauthorized alteration or addition lo fib oowmarn e a vtotatfon of Section 7200 SURVEY F. -t- i 4
of the New York State Education Law.
Certifications indicated hereon shall run only to-the person for whom it is Prepared
radii
nd on his sled h to on and
Company,noes of thele ding In ttu Lending A4 A e . IGW1\/�� Aj
Insutalisted hereon,and to the aesignessGc"of tits MndinO fnsdtutons or tubae•
quem owners. (
Copies of this document not blaring the professional's inked seal or embossed /'� \ TI(1-w {C ) T vJ� O P /may'-
seal shall not be considered a valid true copy. r Y t �s`�1� 1 _ Vvl
The offsets(or dimensions)shown hereon from structures ct res to the property linea are �U C�1 I I ,, / u
for a specific purpose and we and therefore are not Wended to guide the erection of .A IT,f ,/V1LG `�
fences,retaining watis,poofs,patios,planting areas.addition to buildings or any other
construction.
i
Y.
The existence of right of ways and/or easements of record,t any,not shown are ,,G,�� N ./4 , 1 til _