HomeMy WebLinkAboutSchembri Homes Inc (35) �1,_
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JUDITH T.TERRYO�O Gy1�`, Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS O Southold, New York 11971
`
MARRIAGE OFFICER . yj� �. Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER =N. �( ��60 Fax
(516) 765-1800
FREEDOM OF INFORMATION OFFICER 'IS
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1636 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. SCHD REF. #R10-97-0060
Name Of Owner SCHEMBRI HOME INC.
Mailing Address 1 P. O. BOX 163
City St Zip WADING RIVER NY 11792
Property Address 1 HARVEST WAY
City St Zip MATTITUCK NY 11952
Tax Map No. section 120.00 block 3 lot 8.032
Cross Street FARMVEU ROAD
Building Permit Number Cross Reference:
Issue Date: 4/22/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
°LA 114S /
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B X Town Hall, 53095 Main Road
• 0. Obi P.O. Box 1179
II 1D Southold, New York 11971
JUDITH T.TERRY 11`.• 1 TELEPHONE
TOWN CLERK ,\`����'•' (516) 765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office MAR 2 7 1997
DATED: March 27, 1997 E --
Transmitted herewith is a copy of application No. 1705 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 recommendations:
APPROVE
DISAPPROVE
• Comments:
RECEIVED
Signatur
APR 2 2 1997
Dated
Southold Town Er-
. OFFICE OF THE TOWN CLERK
Town of Southold 1,, ' �VFFolKcO Application No. 1 d Cj
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road Construction
P. O. Box 1179 ``� ,, Alteration
Southold, New York 11971
Tele hone 40— $10.00 - Residential
p '
(516) 765-1801 � ��' $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
APPLICANT NAME: .57V.4-Av`-(se
APPLICANT ADDRESS: 0. JNl` / 3 -
'g:`t-- 11/Y( 7901—
SEPTIC CESSPOOL��
DESCRIPT IONA PROP ED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION .OR ALTRA�TION:
OWNER OF PROPERTY:___�L� �-wU�.' G�'" `�1 - --
OWNER MAILING ADDRESS:
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section / 2--u Block 0 Lot 3
CROSS STREET: 6M-^ v et,y BUILDING PERMIT NUMBER CROSS REFERENCE:
//i
Signature of Applicant
RECEIVED BY:
Townerk's ffice
.3/c77.)7/ 71e--‘-"":2
DATE:
n 4 4-77
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THE WATER SUPPLY 8 SEWAGE SUFFOLK COW-lY DEPT. OF
DISPOSAL FOR THIS RESIDENCE -�-- ' HEAL T}i ( t�'IIC f '>FOR y, 1/, a,• i)
WILL CON FROM TO THE STAND- �I T°\I h t'\/ K% API nON;'t `f� (::C.0,4:•.;E'.ONLY . 1�
ARDS OF THE SUFFOLK COUNTY
H.S.REF.140._____ _____la: it I":''-:
DEPT.OF HEALTH SERVICES.
APPROVED BY
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5LtGVATIOt417 1N //t4 /1//t4 /14.1e..47w �:`: ' �°
Unauthorized alteration or addition to This document Is a violation of Section 7209 SURVEY OF: 119-r-
of the New York State Education Law.
Certifications indicated hereon sheN run only to the person for whom It Is prepared /
and on his behalf to the TIN:Company,Governmental pp and Lending MVC .
/,.w /_/ Ou
institution listed hereon,and to the assignees of the lendinginstitutions or subae- I V 1>�1 1 /�/c-Y�sv �j70e 4
quenl
Copiesies of of this document not bearing the professional's Inked seal or embossed Ain TT4t "� � �� Oc- vN o/�
seal shell not be considered s vaNd true copy.
The offsets(or dimensions)shown hereon from structures to the properly lines are ,�,�� �-�/
for a specific purpose and use end therefore are not intended to guide the erection of OL.,K Z�vu'f 1 1 / 1.161A/ YO�(—
fences,retaining waia.pools,patios,planting areas.addition to buildings or any other of NF(..,r
construction.
The existence of right of ways and/or easements of record.if any,not shown — `\
not guaranteed. I, ‘'..(e.;./...-SSUR, DATE: 1.1%�j l q 7 SCALE: I i' ‘0 I
CERTIFIED ONLY T0: r °,.} -:: t DESTIN G. GIirAF
a II4N i• ' ill tl. .., .P:" • . i 100.,
LAND SURVEYOR
By Ot-1 i' t*,041,11C‘EN.S;.... ,...ii...,:.. /:. ',, \
73 WOODLAWN ROAD (�
DESTIN G,GRAF N.Y.S.LIC No.50067 SSW • ROCKY POINT,NEW YORK 11779 V
TAX I.D.No. Topp -- 120- o - pj,32_ PHONE(518)921-3442