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ELIZABETH A.NEVILLE ,I `Z` Hyl; Town Hall, 53095 Main Road
TOWN CLERK p P.O. Box 1179
y Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS �'��, Fax(516) 765-6145
MARRIAGE OFFICER ` Telephone (516) 765-1800
RECORDS MANAGEMENT OFFICER ` 114f ��0'�1�� P
FREEDOM OF INFORMATION OFFICER 01 jig
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2043 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : SCHEMBRI HOMES INC •
Address 1 : 2042 NORTH COUNTRY 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 #R10-99-0069
Name Of Owner POCILLINO CONSTRUCTION
Mailing Address 1 31 TENNYSON AVENUE
City St Zip WESTBURY NY 11590
Property Address 1 1695 AUGUST LANE
City St Zip GREENPORT NY 11944
Tax Map No. section 55.00 block 4 lot 44.023
Cross Street KERWIN BLVD
Building Permit Number Cross Reference:
Issue Date: 5/05/99 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
•oFF00(
ELIZABETH A.NEVILLE Town Hall, 53095 Main Road
TOWN CLERK c -� >> P.O. Box 1179
REGISTRAR OF VITAL STATISTICS irry
Southold, New York 11971
Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER
MARRIAGE OFFICER �:� O Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER a 1 * *%).a""
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: April 30, 1999
Transmitted herewith is a copy of application No. 2145 for a Cesspool/
Septic Tank Construction Permit submitted by:
Schembri Homes Inc. for Posillico
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.
Li da 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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F�1 .16 76` 6145 SOUTHOLD CLERK [2 001
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c� � � Application No. / /
CE OF THE 10 A CLERIC �� \+O %
OFt 1To OF SOL[ ;�riO 01.
`�tL • Construction`
F11ZABe.C11 p'sV iic 11971 ; �
p0,[3 Alteration
501:11101phone ir �Q ►' . $10.00 - Residential
6) 765-1801 �.1 �i..'► $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC'TANK or CESSPOOL
Permit No. I
Fee $
DATE
APPLICANT N AM 1=: $ ç /L44a X"- ----_- -- __-----
APPLICANT ADDRESS: Dz.,a
( -) <<
SEPTIC CESSPOOL
DESCRIPTION F PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: r
OWNER MAILING ADDRESS: ��'' -�. - 31 ---
OWNER PROPERTY ADDRESS: 05 ji4u
TELEPHONE NUMBER OF CONTACT PERSON: /9- 5'f6f
TAX MAP NO. : Section 5---/ Block T Lot Vc4A3
CROSS STREET: K
BUILDING PERMIT NUMBER CROSS REFERENCE:
i� •
Signature of Applicant
RECEIVED BY: _
Town Clerk's Office
DATE:
;,. �` Witt (ONFRnM TO THE STAND-
.
JOB No. AUG-21 ARDS OF THE SUFFOLK COUNTY TAX I.D. No. 1000-53-04-44.23 _
DtF'1.OF HEALTH SERVICES. aV�R�
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ELEV IN ASSUMED DATUM VACANT
[99.31=PROPOSED ELEV
FILE MAP No. 9107 6/3/91
Unauthorized alteration or addition to this document is a violation of Section7209
of the New York State Education Law. SURVEY 0 F:
Certifications indicated hereon shall run only to the person for whom it is prepared LOT 21
and on his behalf to the Title Company,Governmental Agency and Lending
Institution listed hereon,and to the assignees of the lending institutions or
subMAP OF AUGUST ACRES SEC 1
subsequent owners.
Copies of this document not bearing the professional's inked seal or embossed
seal shall not be considered a valid true copy. ARS HAMOMAQ U E TOWN OF SO UTH O L D
The offsets(or dimensions I shown hereon from structures to the property lines are ,
for a s,retaining
purpose and use lading eas and not intended to guide the erection of
SUFFOLK COUNTY, NEW YORK
fences,retaining walls,pools,planting areas,addition to buildings or any other
construction.
The existence of right of ways and/or easements of record,if any,not shown are SURVEY DATE: 3/22/99 SCALE: 1'=40'
not guaranteed.
CERTIFIED ONLY TO: P� -aF Niy rO
SCHEMBRI HOMES Il''. �" DESTI-N G.GRAF '
� DES N G. 'AF
�, c: LAND SURVEYOR
if -..,,, 4-T4t,
rrr'' ,.,
r 73 Woodl- .
t,. yRocky Poi i� 11
By DESTIN G. GRAF N.Y.S. LIC No. 50067 '� eb. �� 516-821- °!
IONA‘-� .,„ 24 ,"")
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