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JUDITH T.TERRY �I Town Hall, 53095 Main Road
TOWN CLERK ; y Z P.O. Box 1179
a e! Southold,New York 11971
REGISTRAR OF VITAL STATISTICS %%‘44 ' 11� Fax(516) 765-1823
MARRIAGE OFFICER N.441 C 1/
RECORDS MANAGEMENT OFFICER ( �a X1 Fax
(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. 1637 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. #R10-97-0059
Name Of Owner SCHEMBRI HOMES 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 8 lot 8.011
Cross Street ALDRICH LANE
Building Permit Number Cross Reference:
Issue Date: 4/22/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
-111.11
/6 3 7
BiqF Town Hall, 53095 Main Road
I•• IP.O. Box 1179
'I�1, ��� J Southold, New York 11971
JUDITH T.TERRY %.� 1 * TELEPHONE
TOWN CLERK •' (516) 765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
C 11 [1
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office 2 7 1997
DATED: March 27, 1997
BLDG. DEPT.
TrWVIv OF SO:'
Transmitted herewith is a copy of application No. 1706 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 /A4-1
Signature
APR 2 2 1997 AV,9
Dated
Southold Town ci r
4, %
A
OFFICE OF THE TOWN CLERK !
'�,
Town of Southold �FrngL+f
Judith T. Terry, Town Clerk Application No. /7h4
Town Hall, 53095 Main Road 4.41. Construction
P. O. Box 1179Alteration
Southold, New York 11971 ; • /
Telephone ,- % &,� $10.00 -Residential Y
(516) 765-1801 =. 1 l ,, 't $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
L4J
D(A4
ATTE
APPLICANT NAME: �, , dLC
APPLICANT ADDRESS: 2o . h (a.3
L-3 6424d iftLi:-. )41_ (1? /(7 .1_
SEPTIC CESSPOOL L-
DESCRIPTION OF PR POSED CONSTR TION OR ALTERATION
„V, 1,--13r,
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATI N
OWNER OF PROPERTY: J ,
OWNER MAILING ADDRESS: 5,-„---( deler
OWNER PROPERTY ADDRESS: _5' dift'Q----
TELEPHONE NUMBER OF CONTACT PERSON: )---1 - 51'07
TAX MAP NO. : Section /2- 0 Block d o Lot �'
CROSS STREET: aUAI
BUILDING PERMIT NUMBER CROSS REFERE E:
/ /
i,/4
/ , , , .
Signature of Applicant
/ A 1
RECEIVED BY:16
Town Clerk's Office
DATE: /G 7 '4
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THE WATER SUPPLY&SEWAGE SUFFOLK COUNTY DEPT.OF
DISPOSAL FOR THIS RESIDENCE HEALTH SERVICES FOR 't' .
e
WILL CONFROM TO THE STAND- APPROVAL OF: cc'+•1s T.ONLY
ARDS OF THE SUFFOLK COUNTY DATE
i`41ni 199/
DEPT.OF HEALTH SERVICES. H.S.REF.HO. _
APPROVED BY j4.6101li Gm Vivi of 11+111th Sante
astanimainotnikia
1 aet/#t11o►K 0-1 A'S1>,11whs..o MAI/Pk .n.
Unauthorized eeeraron or addition this t document is•violation Section 72ot ":—r'•"wwira.
SURVEY OF: 1.,0-rr
of the New York Shite Education taw.
Cereticatons indicated hereon shell run city lo the porton for whom it is prepared
_ hisktbeirsIld
habrson, ie:b t isslp,..enel i42 �'k Ion, r fubM- W14? Of f'Arz frig J IA Ah i 41- 17
quant owners. �!
Copies of this document not bearing e»professional's Inked seat or embossed M Airri-r Yt Lk !Towel of &��
seal smell not be combined a%reed kw copy.
The p setsdflc for dismiss)shown hereon from structuresintended
to Si.guide
,il purposeusenotto erection of !� \K
tences,retaining waee.pools.patios.pimen0 trees.addition to bulldogs or any other
construction.
The sentence of right et ways endror easements of record,If my,not shown OF NE Iy
not guaranteed.
'cP �' I :k EY DATE: Z 114 11"' SCALE: ' /r S
STIN O. R€.r l
CERTIFIED ONLY TO: '"-,y' -o•-• DESTIN G. GRAF
51111
L LAND SURVEYOR
. Ak t-i M... h'1 1BY .
UCE I.rrw .
F` /";`, 73 WOODLAWN ROAD
DESTIN G.GRAF N.Y.S.LIC r.511067 r ��'" ROCKY POINT,NEW YORK 1177.
TAX ID.No. 1000 - 12.o 0 3- 0, u �Stut: + �'
PHONE(515)021-3442