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ELIZABETH A. NEVILLE t Town Hall, 53095 Main Road
TOWN CLERK ; y Z P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ` �', Southold, New York 11971
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RECORDS MANAGEMENT OFFICER RIAGE OFFICER `� "01 .�`a��i��,
Telephone (63 657654 800
FREEDOM OF INFORMATION OFFICER ��
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2423 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : SCHEMBRI HOMES INC
Address 1 : 2042 NORTH WADING RIVER ROAD
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 #R10-00-0106
Name Of Owner KAUFMAN, SCOTT
Mailing Address 1 249 EAST 48TH STREET APT 4A
City St Zip NEW YORK NY 10017
Property Address 1 2705 EUGENES ROAD
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 97.00 block 3 lot 20.002
Cross Street BANKS STREET
Building Permit Number Cross Reference:
Issue Date: 10/10/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE �$1 V% Town Hall, 53095 Main Road
TOWN CLERK % y% = % P.O. Box 1179
REGISTRAR OF VITAL STATISTICS �� Southold, New York 11971
MARRIAGE OFFICER �� y l�,1� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER =_�Ol *go.'
4 , ,� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER _ Jig ���
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: October 5, 2000
Transmitted herewith is a copy of application No. 2511 for a Cesspool/Septic Tank Construction
Permit submitted by:
Schembri Homes Inc for Scott Kaufman
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.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above and make the following
recommendations: /
APPROVE ✓
DISAPPROVE
Comments:
S ature
to IS /0 0
Dated
OFFICE OF THE TOWN CLERK 1''1COULKe "
TOWN OF SOUTHOLD /k
QG Application Noa
ELIZABETH A.NEVI LE,TOWN CLERK i
P.O.BOX 1179 L Construction
SOUTHOLD,NEW YORK 11971 OT •
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