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JUDITH T.TERRY $ Town Hall, 53095 Main Road
•
TOWN CLERK c • P.O. Box 1179
• �. n� Southold, New York 11971
REGISTRAR OF VITAL STATISTICS 4 �1 Fax (516) 765-1823
MARRIAGE OFFICER � yijO 40.1.1 Telephone
Telephone (516) 765-1800
RECORDS MANAGEMENT OFFICER .( .11
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. 1600 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. #R10-97-0008
Name Of Owner SCHEMBRI HOMES INC.
Mailing Address 1 P. O. BOX 163
City St Zip WADING RIVER NY 11792
Property Address 1 HARVEST LANE
(LOT 12)
City St Zip MATTITUCK NY 11952
Tax Map No. section 121 .00 block 7 lot 1 .000
Cross Street FARMVEU ROAD
Building Permit Number Cross Reference:
Issue Date: 3/20/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY �$ Z< Town Hall, 53095 Main Road
TOWN CLERK y ? P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS �Oy � �� Fax(516) 765 1823
MARRIAGE OFFICER � � .a�
RECORDS MANAGEMENT OFFICER �fell �►•
•',1 Telephone (516) 765-1800
/
FREEDOM OF INFORMATION OFFICER • •�•�
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: February 10, 1997
Transmitted herewith is a copy of application No. 1666 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:
RECEWED
Signature
MAR 1 9 1997 3/4
3;
OFFICE OF THE TOWN CLERK
Town of Southold ' f e1,� r
Judith T. Terry, Town Clerk = Application No.' 1
Town Hall, 53095 Main Road
P. O. Box 1179 Construction L/
1-4
Southold, New York 11971
Alteration
Telephone
$10.00 -Residential
(516) 765-1801 411 �► �
•
$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 / -- (u h 7
APPLICANT NAME: CIPA^Al (A--pV„14
APPLICANT ADDRESS: (Q 415X ( c '2)
/UV -7q
SEPTIC
SEPTIC CESSPOOL.
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY:
OWNER MAILING ADDRESS:
OWNER PROPERTY ADDRESS:
/el-
TELEPHONE NUMBER OF CONTACT PERSON: 1 -al91�
TAX MAP NO. : Section /4 ( Block ° -7 Lot U / • v
CROSS STREET: ' 6CA114,,t\k,u
BUILDING PERMIT NUMBER CROSS REFERENCE:
//
•
Signature of Applicant
RECEIVED BY: I
Town Clerk's ice
DATE: .//p/97
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THE WATER SUPPLY&SEWAGE SUFU(COUNTY DEPARTMENT OF lizALTH siiimail
SUFFOLK COUNT DEPT.OF
DISPOSAL FOR THIS RESIDENCE t r _ FOR APPROVAL OF aQiiT1EE1C'!"101t vat A
HEA,_TI'r o._I<L'f..,E FONT
WILL CONFROM TO THE STAND-
APPROVAL VAL OF C.O S I.ONLY7Giolef.ZARDS OF THE SUFFOLK COUNTY DATE__ :)ATE ' . 1 ? ./2./ 0-7 FAh1CLY iti�C�ONLY 7—0994
DEPT.OF HEALTH SERVICES. H.S.REF.NO._.__ *PP ED _
APPROVED BY NW—MAXIMUM OP4
f-i-e•laylerS14 A55u t4 Amos,. EXPIRES THREE YEARS IIMM DATE CV AIS.
unwitisi e4 awrwarr or WSW to this document Is a violation of Section 7209 SURVEY OF: 1,.•,-, /-'1-------------------_--
of a.New vara Stals f8du"atan law.
Gar alone Woofed hereon OM M aNy b tlN for whom It b PraPered D � �� f
andonMoMMMN10MMTalotothC" gy. �Y 17
NWllydsr,/M�/hereon.and b IM NalofNar of IM tNuMoubN-
quint owners:
ts considered onal's Inked goal or e mbo...d MATY' -r wx— ,Tov►.I *
6cvnil1/404,
sell shall Tito ofw.fs for dimension)shossn hereon bum structures to the property lingo are l'
for a ipecac purpose and use and Iherefors ere lances Mining w.re pat,o rias,Wendedad to or any guide the other eer OE N �: �, p L T7� d`l�W �fC.j� ..
co he atop. . .
The Wd t cs at right of ways and/or segonsnts of record.If any.not shown p'� r � *
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CERTIFIED ONLY TO:// ' L� r- fi " 2"!'t '; DESTIN G. GRAF
. / LAND SURVEYOR
LICENSE 40 ,,: 0.ti
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DESTIN G.GRAF N.Y.S.LIC No.50067 ROCKY POINT,NEW YORK 11778