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ELIZABETH A. NEVILLE ���/�� y1: Town Hall, 53095 Main Road
TOWN CLERK ; y = P.O. Box 1179
REGISTRAR OF VITAL STATISTICS PetSouthold, New York 11971
MARRIAGE OFFICERS y �1 Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER =_ '�491 se Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ,���r�'
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2427 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 #R10-00-0174
Name Of Owner SCHEMBRI HOMES INC
Mailing Address 1 2042 NORTH WADING RIVER ROAD
City St Zip WADING RIVER NY 11792
Property Address 1 175 THE CROSS WAY
City St Zip EAST MARION NY 11939
Tax Map No. section 30.00 block 2 lot 14.000
Cross Street THE LONG WAY
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 ��= GZ1: Town Hall, 53095 Main Road
TOWN CLERK ; y Z • P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER �: y ���1, Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER =_�Ol ������� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER • •°°,i'
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: October 6, 2000
Transmitted herewith is a copy of application No. 2517 for a Cesspool/Septic Tank Construction
Permit submitted by:
Schembri Home, 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.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments:
$69r—
ature
'oh
Dated
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OFFICE OF THE TOWN CLERK ,,s."%1 FFOLKG —
TOWN OF SOUTHOLD 1�OQ QG = Application No.R
ELIZABETH A.NEVILIF,TOWN CLERK
• P.O.BOX 1179 Construction V
SOUTHOLD,NEW YORK 11971 Z
Alteration
crs
Telephone �Q��i� $10.00 - Residential
(631) 765-1800 1 4�,��' $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE 40/6/06
APPLICANT NAME: L')i / i0�S
APPLICANT ADDRESS: , -(9'-/> L a/l b/,YC, 4/14,:')/6 /e_gz
SEPTIC /CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
• OWNER OF PROPERTY: -S1/L& ,I
OWNER MAILING ADDRESS: .2t C!/,L j�/.J( ,�jG� , tad-2)
Gt.104-6i/bp, 7
OWNER PROPERTY ADDRESS: c L C2OSS tu,1y4/ DoT /3
s7 rn 2. n
TELEPHONE NUMBER OF CONTACT PERSON: 7c>.0)- - Sec//
TAX MAP NO. : Section 30 Block 02\ Lot
CROSS STREET: 7-77/Z--- -'2 /
BUILDING PERMIT NUMBER CROSS REFERENCE:
Ae/
ignature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
JOB No. 00-40 TAX I.D. No. 1000-30-02-14
•
LOT 41 LOT 42 LOT 43 LOT 44VACANT VACANT
OCC RES PW VACANT
97.6 97.3 THE CROSS WAY [ 60' ]
EDGE OF PNMT .. — — —' — R=20.00'
N 83°27'45"E 77.73' L=29.16'
1 96.4
96.8 �C TIE 115.89'
m
\It r
LOT 14 \P • 60' LT LOCC1RES PW Z
VACANT \ 0
15
6„.5 D `G;
P,6F M\\� TE
1]OTEST HOLES ON FILE MAP SHOW CLAY
\0 S �'� AND SAND EAST OF SUBJECT LOT
3.
21 LEACHING POOLS MUST BE BACKFILLED
N WITH CLEAN SAND AND GRAVEL IN
N ACCORDANCE WITH SUFFOLK COUNTY
NG R9 8 HEALTH DEPT.STANDARDS.
0 01O
O 1T
'Z
LI es)
-a
C3) CP
N
N
SUFFOLK COUNTY DEPARTMENT OF H LTH SERVICES
PERMIT Eon APPROVAL OF CONSTRU+TION FCR A
SINGLE FAMILY RESIDENCE 0(\ L'V
DATE —9.-S H.S. REF. NO. , - 0
APPROVED_ -41111i -11 '
Fort MAXIMUM OF f :EDROO S j i
EXPIRES THREE YEARS FROM DATE OF AP' ROVAL 9e.o
98.6 .:_i
S 83°27'42"W 77.73' ' '
ELEV IN ASSUMED DATUM FILE MAP No.6266 6/11/75
Unauthorized alteration or addition to this document is a violation of Section 7209
of the New York State Education Law. SURVEY O F:
Certifications indicated hereon shall run only to the person for whom it is prepared LOT 13
and onhis stedhtothe Tnde Company,signGovernmental digcy and Lnor MAP OF PEBBLE BEACH FARMS
Institution listed hereon,and to the assignees of the lending institutions or
subsequent owners.
Copies of this document not bearing the professional's inked seal or embossed
seal shall not beconsidered avalid true copy. EAST MARION, TOWN OF SOUTHOLD
The offsets[or dimensions)shown hereon from structures to the property lines are
for a specific purpose and use and therefore ars 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: 6/29/00 SCALE: 1"=40'
not guaranteed.
CERTIFIED ONLY TO: 0:' Po,':,. tot,
,
SCHEMBRI HOMES 44� O DESTIN G.GRAF
y OeSTNn I1RAF �' LAND SURVEYOR
• r
�_ I. fu 73 Woodlawn Road
N ,Y.4 . . Rocky Point, N.Y. 11778
�T • �1 05"• 516-821-3442
By DESTIN G. GRAF N.Y.S. LIC No. 50067 A
, `sSIO A