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ELIZABETH A. NEVILLE t� & �y ; Town Hall, 53095 Main Road
TOWN CLERK p -� P.O. Box 1179
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REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER 1 Fax (516) 765-6145
RECORDS MANAGEMENT OFFICER ` 4 0" �I Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER `. ' 4I `�►of P
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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. 2235 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 #R10-99-0261
Name Of Owner POCILLIO CONSTRUCTION
Mailing Address 1 PO BOX 728
City St Zip AQUEBOGUE NY 11931
Property Address 1 AUGUST LANE
City St Zip GREENPORT NY 11944
Tax Map No. section 53.00 block 4 lot 44.024
Cross Street AUGUST LANE
Building Permit Number Cross Reference:
Issue Date: 2/08/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE •ti`1` y ; Town Hall, 53095 Main Road
TOWN CLERK o P.O. Box 1179
REGISTRAR,OF VITAL STATISTICS % �� Southold, New York 11971
MARRIAGE OFFICER
O •F Fax(516) 765-6145
RMQQ T OFFICER ?IL 0. Telephone (516) 765-1800 00
FE$ DOq@CRF F ON OFFICER � .0_,4
JAN i 2000 OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: January 27, 2000
Transmitted herewith is a copy of application No. 2323 for a Cesspool/
Septic Tank Construction Permit submitted by:
Schembri Homes Inc. for Posillico Construction •
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:
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Dated
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OFFICE OF THE TOWN CLERK 1s.,,,\/`,`,'•••••••,n,,,
TOWN OF SOUTHOLD %%4Z�`FD�KCOv=• Application Not\
ELIZABETH A.NEVII.I.F,TOWN CLERK O
P.O.BOX 1179 : -'
Construction
SOUTHOLD,NEW YORK 11971 : = "rn
Alteration
Telephone - Q��' $10.00 - Residential✓
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(516) 765-1801 Ol * 000.. $25.00 - Non-Residential
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION RECEIVED
for JAN 2721X13
CONSTRUCTION or ALTERATION PERMIT #,,,yyhorci rown Clerk
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE
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APPLICANT NAME: ' -
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APPLICANT ADDRESS: ��-S �.; -:.�.:_, _ i - -
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SEPTIC CESSPOOL t
DESCRIPTION OF PROPOSEDONST CTION OR ALTERATION
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCT OR LTERAT N:
OWNER OF PROPERTY:
OWNER MAILING ADDRESS: - • • I am,.
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OWNER PROPERTY ADDRESS:
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TELEPHONE NUMBER OF CONTACT PERSON: 9--a2 ? "3-r Cl
TAX MAP NO. : Section ��5 Block 0 5( Lot VV A V
CROSS STREET: --
BUILDING PERMIT NUMBER OSS REFERENCE:
Signature of Applicant
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RECEIVED BY .
wn Clerk's Office
DATE: 1la1IOC'
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ELEV IN ASSUMED DATUM . • FILE MAP No. 9107 6/3/91
Unauthorized alteration or addition to this document is a violation of Section 7209 LOT 2L
I of the New York State Education Law. SURVEY OF:
certifications indicated hereon shall run only to the person for whom it is prepared
and on his benalf to the title Company,Governmental Agency and Lending MAP OF AUGUST ACRES SEC 1 I�,
Institution listed hereon aria to the assignees of the lending institutions or 11
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