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ELIZABETH A.NEVILLE ; Town Hall, 53095 Main Road
TOWN CLERK o - P.O. Box 1179
, Southold, New York 11971
REGISTRAR OF VITAL STATISTICS Fax(631) 765-6145
MARRIAGE OFFICER `;�' .0 Tele hone (631) 765-1800
RECORDS MANAGEMENT OFFICER _ *a00P
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. 2285 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : SCHEMBRI HOMES INC
Address 1 : PO BOX 728
City St Zip AQUEBOGUE NY 11931
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 #R10-98-0267
Name Of Owner CUMMINGS, SERENA
Mailing Address 1 16 ARLEIGH ROAD
City St Zip GREAT NECK NY 11021
Property Address 1 90 SHORE LANE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 86.00 block 1 lot 4.016
Cross Street INDIAN NECK LANE
Building Permit Number Cross Reference:
Issue Date: 4/14/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE ,���� Gt: Town Hall, 53095 Main Road
TOWN CLERK C P.O. Box 1179
y Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICSv' %
MARRIAGE OFFICER G Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER `=y'/Ol ��i��, Telephone (631) 765-1800
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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: April 3, 2000
Transmitted herewith is a copy of application No. 2373 for a Cesspool/
Septic Tank Construction Permit submitted by:
Schembri Homes
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 appli tion and location map of the project cited above
and make the following r commendations:
APPROVE
DISAPPROVE
Comments:
Signatur
L/f3 ( oo
Dated
OFFICE OF THE TOWN CLERK ,,''�\\�FOLk 3�7
TOWN OF SOUTHOLD '��'O% COG Application No. /
ELIZABETH A.NEVILLE,TOWN CLERK
P.O.BOX 1179 :
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