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ELIZABETH A. NEVILLE d 14d Town Hall, 53095 Main Road
TOWN CLERK ; P.O.Box 1179
REGISTRAR OF VITAL STATISTICS • �, Southold, New York 11971
MARRIAGE OFFICER ` � `� 1 Fax (631) 765-6145
•
RECORDS MANAGEMENT OFFICER ®P 11le Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER _ `Ls �//
OFFICE OF THE TOWN CLERK
SOUTHOLD 1,36/ITIDWEERISIMENDSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2570 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. RER10-99-0262
Name Of Owner PETER SCHEMBRI HOMES INC
Mailing Address 1 PO BOX 728
City St Zip AQUEBOGUE NY 11931
Property Address 1 SHORE LANE
City St Zip PECONIC NY 11958
Tax Map No. section 86.00 block 1 lot 4.014
Cross Street INDIAN NECK LANE
Building Permit Number Cross Reference:
Issue Date: 5/01/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE i�� - ; Town Hall, 53095 Main Road
Ai
TOWN CLERK % ® P.O. Box 1179
%REGISTRAR OF VITAL STATISTICS
�` Southold, New York 11971
MARRIAGE OFFICER :‘1710:,'
.�,it, � ���1 Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER '/®� �®le/� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER jig ,l'
-....•'�
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: April 27, 2001
Transmitted herewith is a copy of application No. 2661 for a Cesspool/Septic Tank
CONSTRUCTION/ALTERATION Permit submitted by:
Schembri Homes for Pete Schembri
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:
APPROVEAV
. DISAPPROVE
Comments: Maintain required setbacks from adjacent wells,buildings,property lines and water
Bodies. EXCAVATION INSPECTION REQUIRED. .
Signature
4/ sc Jo f
Dated
OFFICE OF THE TOWN CLERK ��, ��FFOCKCQ
_
TOWN OFSOUTHOLD �� = Application No. 24" 42/
FT T7ABETH A.NEVILLE,TOWN CLERK
P.O.BOX 1179 Construction D�>
SOUTHOLD,NEW YORK 11971 co • T
Alteration
Telephone O *4 •Vy $10.00 - Residential
�I
(631) 765-1800 -=��1 I.
$25.00 -Non-Residential
TOWN OF SOUTHOLD ✓
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE 11lkI
APPLICANT NAME: Sciycnibre1,, -PVlie s �rC"
APPLICANT ADDRESS: Pb >C 7Z
► o (i ) I.lct31
SEPTIC CESSPOOL
DESCRIPTION OF " aPOSED� NST CTION OR ALTERATION
/ /„J-
LOCATION
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C-
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: {Pe- Scin-cnabel
OWNER MAILING ADDRESS: ?o ' & 1r727
pav-e bO6 ) 11 1 1 q3/
OWNER PROPERTY ADDRESS:, .
TELEPHONE NUMBER OF ONTACT PERSON(cp3() 72-2_ F'W
TAX MAP NO. : Section Bloc 41'_i I Lot '�.
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature f Applicant
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RECEIVED BY:, ,;
• Cler 's Office
DATE: ' Au
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