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ELIZABETH A.NEVILLE f� yam► •
Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
i N Southold, New York 11971
REGISTRAR OF VITAL STATISTICSFax (516) 765-1823
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER oy�0 �0�� Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER � � '�o�i
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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. 1985 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : SCHEMBRI HOMES INC.
Address 1 : PO BOX 163
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 #R10-98-0131
Name Of Owner SCHEMBRI HOMES INC.
Mailing Address 1 PO BOX 163
City St Zip WADING RIVER NY 11792
Property Address 1 WATER TERRACE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 88.00 block 6 lot 13.003
Cross Street AVENUE OF TREES
Building Permit Number Cross Reference:
Issue Date: 12/23/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE P\.0 O �l/y Town Hall, 53095 Main Road
TOWN CLERK t =.Z1 P.O. Box 1179
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REGISTRAR OF VITAL STATISTICS rrt
Southold, New York 11971
MARRIAGE OFFICER 1� Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER '124 0. ,�� Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER �����1
... •••
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: December 15, 1998
Transmitted herewith is a copy of application No. 2064 for a Cesspool/
Septic Tank Construction 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.
Thank you.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following reco .mendations:
APPROVE
DISAPPROVE
Comments:
ignatur
/ 11/ 4./IT
Dated
•OFFICE OF THE TOWN CLERK '''•COUL/'
TONOFSOUTHOLD ,`14 Q
WG Application No.020Gil
FT IZABETH A.NEVII-I F,TOWN CLERK
P.O.BOX 1179 !1 Construction L/
SOUTHOLD,NEW YORK 11971 z F Z
Alteration
•Zs in rit 7 , $10.00 - Residential
Telephone __j��j' ��,. •
(516) 765-1801 ' -1 o�,," $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
P I eriVlw
for
DEC 1 5 1998
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL tont Clerk Southold
Permit No.
Fee $ ,�,.�
DATE %) /J i
APPLICANT NAME: S O""`
APPLICANT ADDRESS: 120- f (, -5
ui K/c l ( 7q.)--
SEPTIC
q.)--
SEPTIC CESSPOOL t/
DESCRIPTIONOF ROPO ED CONST' UCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTQERRATION:
OWNER OF PROPERTY: • � i,g Ali, -.
OWNER MAILING ADDRESS: flo / A, 3
Cid i--43 flie
PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: i1 _ c6
TAX MAP NO. : Section c Block OCD Lot 13-- 5
CROSS STREET: l�Ti^"41^-.: ��
BUILDING PERMIT NUMBER CROS REFERENCE:
ort/ ri / //
.<1
ignature o Applicant
RECEIVEDL
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BY: C
Town Clerk's Office
DATE: -(I 4c S
of3 1 - 4S
.. THE WATER SUPPLY&SEWAGE
DISPOSAL FOR THIS RESIDENCE
WILL CONFROM TO THE STAND-
\h,l'4C\Z":::. Offe14 PAE.6
ARDS OF THE SUFFOLK COUNTY
DEPT OF HEALTH SERVICES.
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v.1 r ye-or - — 2s I - •° 1
Received —/Ant
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d.Urliy
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SEP 0 3 1998 1 "Ni- 1 P. 4!I.,Q L- 3
)epi. VZ ri aii`1 Se vices1 / I_ Y I r
Fice f Wastewater Mont.
---���" 103.3 1D1.0
�02.t a-o 1 - ••V./ i 5 ,0 0
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SUFFOLUNTY DEPART�I IEENNT OFZHEALTH SERVIC ;� LST 21
PE FOR APPROVAL OF,4 UC ION FOR A Dwist.-1•4 G- Q`^J,
SINGLE FAMILY/ 3itNCE ONLY
DATE "--I HS ; F.N a -a f 4i1C'613
APPROVED ..illtr/ %rA' / A
FOR MAXIMUM OF -OOMS
EXPIRES THREE YEARS FROM DATE OF APPROVAL
IiJ Aus - I•t: '�o`-►z- 81231
Unauthorized alteration or addition to this document is a violation of Section 7209 SURVEY OF: 1 All
of the New York State Education Law. "�� "�� 11
Certificationsnhisindicated thted tlerConpan run onlyrto the person for whom it is prepared MN? � L/ 4-f-oy. ...12
and on his behalf to the Title Company,Governmental Agency and Lending ?/'TrIVIt
Institution listed hereon,and to the assignees of the lending institutions or subse-
quent owners. �614
O v L\1 ' I
Copies of this document not bearing the professional's inked seal or embossed Yv' �J� T1}I-{'Y]�1���
seal shall not be considered a valid true copy. 1�� y � ,�/ /� �/Tae offpe etsific (ur os eand s)shown eereoe froare of intendse t tag property lrecti nro / ,��iCiL �I ' 1 1 VV`� �Fig.
for a speafie purpose and use and therefore are not intended to uide the erection of V r(/ice`
fences,retaining walls,pools,patios,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
not guaranteed. �G of Nil , -s DATE: 81(.) SCALE: I , i
CERTIFIED ONLY TO: - yrDEIST N G. -- DESTIN G. GRAF
a _ it ■LL. 7i ' , N)it 1(
` r#Ip LAND SURVEYOR
_.,
73 WOODLAWN ROAD
DESTIN G.GRAF N.Y.S. LIC No.50067 •,r 4 A7
le ROCKY POINT,NEW YORK 11778
TAX I.D.No. 1000—SS-0(5— 13,3 • •Y: ;NA s. v PHONE(516)821-3442