HomeMy WebLinkAboutSchembri Homes Inc (36) ooti 4004
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JUDITH T.TERRY �•=�0 Gy �\` Town Hall, 53095 Main Road
TOWN CLERK C - qk P.O. Box 1179
. t Southold, New York 11971
REGISTRAR OF VITAL STATISTICS � Fax (516) 765-1823
MARRIAGE OFFICER ‘#* �Q�I��� Telephone (516) 765-1800
RECORDS MANAGEMENT OFFICER •( • '� ��1
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. 1694 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. SCHD REF. #R10-97-0102
Name Of Owner SCHEMBRI HOMES INC.
Mailing Address 1 P. 0. BOX 163
City St Zip WADING RIVER NY 11792
Property Address 1 ALDRICH LANE
City St Zip MATTITUCK NY 11952
Tax Map No. section 120.00 block 3 lot 8.036
Cross Street HARAVEST LANE
Building Permit Number Cross Reference:
Issue Date: 6/30/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY 1t��O Gym � Town Hall, 53095 Main Road
TOWN CLERK o= 1 , P.O. Box 1179
ti Southold, New York 11971
REGISTRAR OF VITAL STATISTICS O # Fax(516) 765-1823
MARRIAGE OFFICER 4, �0'1Telephone (516) 765-1800
RECORDS MANAGEMENT OFFICER 1 'A
FREEDOM OF INFORMATION OFFICER ‘iii
��d
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: June 26, 1997
Transmitted herewith is a copy of application No. 1764 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 tioV
DISAPPROVE
Comments:
U.
iignatu
c. /2- /4 -7
Dated
OFFICE OF THE TOWN CLERK ",,,, ,
Town of Southold
Judith T. Terry, Town Clerk Application No.(7
+�' "
Town Hall, 53095 Main Road •LV= Construction
P. O. Box 1179 ffi
Southold, New York 11971 = Alteration u`J,
Telephone $10.00 - Residential l—_
' j � ---
(516) 765-1801 '--""1 lit ��,
,, $25.00 -Non-Residential
• -- , . ii' -....
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT.
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE 4/4//7
APPLICANT NAME: ScLe.,„.,4‘:
APPLICANT ADDRESS: / C2
SEPTIC CESSPOOL �—
DESCRIPTION OF ROPOS CONS, RUC, ION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRU I N OR LT RATION:,(
OWNER OF PROPERTY:
�� ��.
OWNER MAILING ADDRESS: 'p Q , -L,�I _
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OWNER PROPERTY ADDRESS: t # -
TELEPHONE NUMBER OF CONTACT PERSON: 9/L-/
TAX MAP NO. : Section / P O Block 03 Lot V ` 3 5�
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of Applicant
RECEIVED BY:
Tow. C erk's Office
DATE: � l _
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SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES wtsw
P*Aill@F POR APPROVAL OF OOKTRUCrION FOR A
SINGLE FAMILY Eli ATM',/".!•ONLY
DATE JUN , : :7 :iii lip-,: r 1: " i 611 3
lid .'.r..-,r► -r
t
APPROVED -- _ _ .� s
FOR MAXIMUM OF eABDROOMS V
EXPIRES THREE YEARS FROM RATE OF APPROVAL 9 Z
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.A.4.772. : Gve// l71.4.5 7- 6A ,.�-oc.v ¢2 V)
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THE WATER SUPPLY R SEWAGE
DISPOSAL FOR THIS RESIDENCE cAir_ tau l l -••..__.__.._
WILL CONFROM TO THE STAND- PLEASE NOTE
ARDS OF THE SUFFOLK COUNTY Minimum distancebetween well
DEPT.OF HEALTH SERVICES. and cesspool is to be 150 feet.
Unauthorized alteration or addition to this document is a violation of Section 7209 SURVEY OF:
of ie the New York$pEducation haw. 1....o-r- A,
Certifications MOWN'hereon she run only to the person for whom It is prepared �,
and on his ealtw b fins rw.Carparny. WerrrtuenWW Aosenep elle t.«nang AAA( o �/\112.14#W0,4 T* ..V c
In.titution Mated Ineraon,and b tine assignees d tM NwltrrtiorM or tubee �+
Copia d uent Ns document not beefing the professional's Inkedseal a embossed MArTr1'C'V1 G.k 1 1 iW N 012
seal shall not be considered a weld true ow.
TM offsets(or dlnnernsiongehewn lweon - etruplura to IM prep.Ay tee an �U��1 / ✓_ ,,,,�/' Kiev,/
E
lora.pedlk purpeaa and tree and therabre ) b pul0e tM emeetion d L- . c..f/ N 1, 1 f i
. lance.,rosining walts,pools.patlos,planting ,,_ - to buildings or any other
con.truclon. t
�> a night d way.erwror /,t , i* / n are ��'OF 4E% 1` Y DATE 5 .1t1 SCALE: I
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CERTIFIED ONLY T0: .. J(/ :, t •ESTIN 3.. ra� �►
/ , q 'r DESTIN G. GRAF511i
. X.'i LAND SURVEYOR
•
By J , A ,LIC a it;a;; ':r. i, 73 WOODLAWN ROAD
9
_ DESTIN G.GRAF N.Y.S.UC No.50067 j , ROCKY POINT,NEW YORK 11778
TAX I.D.Na I000 _ (Zo- 03 - 8.3(i � U
•k',tya: f/ PHONE(518)821-3442
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