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ELIZABETH A. NEVILLE ��_ yet: Town Hall, 53095 Main Road
TOWN CLERK ; y 2 k P.O. Box 1179
REGISTRAR OF VITAL STATISTICS 1 Southold, New York 11971
MARRIAGE OFFICER .\414,
y ���1,, Fax (631) 765 6145
RECORDS MANAGEMENT OFFICER -X01 **tile
,,�� Telephone (631) 765-1800
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. 2437 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 #R10-00-0188
Name Of Owner SCHEMBRI HOMES INC
Mailing Address 1 2042 NORTH WADING RIVER ROAD
City St Zip WADING RIVER NY 11792
Property Address 1 1683 ROBCKY POINT ROAD
City St Zip EAST MARION NY 11939
Tax Map No. section 30.00 block 3 lot 12.000
Cross Street MAIN ROAD
Building Permit Number Cross Reference:
Issue Date: 10/18/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE �o Gyd: Town Hall, 53095 Main Road
TOWN CLERK ; y P.O.Box 1179
REGISTRAR OF VITAL STATISTICS � Southold, New York 11971
MARRIAGE OFFICER y ��F�1� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER �_��l .���r�i� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER
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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 17, 2000
Transmitted herewith is a copy of application No. 2525 for a Cesspool/Septic Tank ALTERATION
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.
,�lilc.�cv
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE ✓
DISAPPROVE
Comments: Maintain required setbacks from adjacent wells,buildings,property lines and water
Bodies. EXCAVATION INSPECTION REQUIRED.
ignature
[v'f"1I o0
Dated
OFFICE OF THE TOWN CLERK '�'c_ �1 1 UL'i �
TOWN OF SOUTHOLD �� CQG Application No.o1�3 �S
ELIZABETH A.NEVI LE,TOWN CLERK
P.O.BOX 1179 • Construction 04_
SOUTHOLD,NEW YORK 11971
Alteration
Telephone •jyo i•0�,�'
$10.00 - Residential
(631) 765-1800 - 1 ,t°' $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE %6//766
APPLICANT NAME: �S(;c,L� �,e/ h�-0• G S zx1�
APPLICANT ADDRESS: 46 y�- ,i, /�/h)/.v(,,
/ I)1IJr.v� I/W / . /l-79�.
SEPTIC t/ CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: - Go /-/4=p", Rte/ .
OWNER MAILING ADDRESS: ,90c.4?.. L). OVAL/i0 / j(-6
/, )AZ) J,c 'et /(7 9 2-
(DRS ffi ?OWNER PROPERTY ADDRESS: ���-�-�= --
TELEPHONE NUMBER OF COQ OTACT PERSON: -% (7/
TAX MAP NO. : Section - Block - .r- (, Lot / A-
CROSS STREET: /y /ed /e-O
BUILDING PERMIT NUMBER CROSS REFERENCE:
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natu ��
RECEIVED BY:
/4/ �Tow Clrrk's Office
DATE: ' 6aPP
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1 1 tr^POLX COUNTY DFPA:LT 1ENT OF I:ALM SERVICES
, a'E 011 C, rt1OVAL OF CONc'TRUCTION FORA 4..
a1NCLE 11A1'41LY RItS D::NCE ONLY
OCT OU000 K o (1.i o - oo - J SF
vPROVED
FOR MAXIMUM OF 2 BEDROOMS
v:
1 EXPIRES THREE YEARS FROM DATE OF APPROVAL25
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ELEV IN A88UMB)DATUM FILE MAP No.a750 61711E ; 4,1
anal tiaw+Aii WING Wound r Hbrron d$s on 7202SURVEY OF:
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�P �- spell poab oM�orrNr wr wiry b e..wroo«.ar aiw
perm w., GRAF EVA afwasandbr aaaanrwb.atmn4 r.o,n«sham ua SURVEY DATE: 7/20/00
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r- '' ' CERTIFIED ONLY TO:
• '�'': SCHBAsw HOMES DESTIN G.GRAF . 1,'
LAND SURVEYOR
73Woodlom Mord ,
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ItseN/ftlaL Nw Yak 11770
01•4821-6142
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