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066
ELIZABETH A.NEVILLE 11.Awf Town Hall, 53095 Main Road
TOWN CLERK ` P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold,New York 11971
Fax(631) 765-6145
MARRIAGE OFFICER :®� ®t +' hone (631) 765-1800
RECORDS MANAGEMENT OFFICER ; ®l Telephone
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
SOUTHOLD SISAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2712 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
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 #R10-01-0231
Name Of Owner SCHEMBRI HOMES INC
Mailing Address 1 2042 NORTH COUNTRY ROAD
City St Zip WADING RIVER NY 11792
Property Address 1 2495 ROCKY POINT ROAD
City St Zip EAST MARION NY 11939
Tax Map No. section 30.00 block 3 lot 4.000
Cross Street ROUTE 25
Building Permit Number Cross Reference:
Issue Date: 12/17/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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• DEC 1 3 21'sb f
ELIZABETH A. NE 1!► ti it • 'yam ; Town Hall, 53095 Main Road
TOWN CLERK J ; P.O. Box 1179
'k _ BLDG. DE• - i ; Southold, New York 11971
REGISTRAR OF VITAL ST•TIS°I' �: e F S•U►U,, � �,+ Fax (631) 765-6145
MARRIAGE OFFICE'' sfv
RECORDS MANAGEMENT OFFICER � ®� -*����" Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: December 13, 2001
Transmitted herewith is a copy of application No. 2807 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.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments:
.°91°L#49g41-41/44'-
Signature
/ /3 /0/
Dated
OFF7CE OF THE TOWN CLERIC
;,.. .60
.. TOWN OFsouruoLD J'o C,, - Application N
..... ELIZABETH NEVILIE,TOWN CLERK
1Q .</
1 J PO BOX 1179 tiConstruction
SOUTHOLD,NEW YORK 11971 arn i
iI ; Alteration i
�
Telephone - '0#. ,.a0''�.�' $10.00 -Residential
(63t) 765-1800 -----_40/ . $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
I
Permit No.
Fee $
DATE /62/1/.... A
APPLICANT NAME. SC_J"1Qr' Y—! ) .
APPLICANT ADDRESS: a1Y* /V, 311 �
N i )Y 1 n ),0 1 )c7< ..
SEPTIC CESSPOOL 1
DESCRIPTIOC�NSTR
OF PRO OSED CUCTI N ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONST UCTION OR ALTERATION: �
OWNER OF PROPERTY: , br-1 ��yFa'S
OWNER MAILING ADDRESS: ,xj_c.,:),_ _i?..d.
y\h5j1-4-A9-
OWNER PROPERTY ADDRESS.:Q�d l �RGky -PioiM
TELEPHONE NUMBER OF/(X)r)
PERSON:
/� ��qy0 4/
TAX MAP NO.: Section/`"� BIocK' e �T
CROSS STREET:'7%-i'�QS
BUILDING PERMIT NUMBER CROSS REFERENCE. dt
.,(...„..._ ‘
Signature of Applicant
RECEIVED BY:
own Clerk's Office
DATE. l' \151C)
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OPEN SPACE 3u roL t f;Dllt�1V DEPARTMENT o �$EAI.TR BER1(uCto ,; .xa
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PERMITOR APPROVAL O CONSTRUCTION FoR A -.\„.-,
SINGLE
StGLE FAertitEStDErac 0�1LY ' i
f 13 61 t c�toF. ®. O.).ALL DISTANCES TO WELLS AND CESSPOOLS 1 /
APPROVED
ARE BY LOCATIONS FROM HOMEOWNERS, BisRc0M� -
FIELD OBSERVATIONS, AND EXISTING ®�` 'ja't'" �D . -
SURVEYS. SINCE MOST ARE NOT VISIBLE EXPIRE' m I°IRN• ' ' r '3 '__" "__ �_--- `� ' -
THESE DIMENSIONS ARE NOT CERTIFIED. " �-
I S:R 25\ r .
ROPO � r ,.
MP\IA i <
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ELEVATIONS IN ASSUMED DATUM' FILE MAP No.8759 617189 „
Unauthorized alteration or addition to this document is a violation of Section 7209 I - .,:
of the New York State Education Law- SURVEY OF: ---A r•••,.,-
, t
Certifications indicated hereon shall run only to the person for whom ft is prepared LOT 14
and on his behatf to the Title Company,Governmental Agency and Lending
Institutions listed hereon,and to the assignees of the Lending Institution or MAP OF EAST MARION WOODS
subsequent owners, ,'
Copier,of this document not-beating the professional's inked seal or embossed EAST MARION; TOWN OF SOUTHOLD seal shall not be considered a valid trite copy: -
The dfsets t or dimensions J shown hereon from structures to the property lines are - - -
p. �'. NE4yr0 feer or specific tconstructi�alnlnpgwplfs p use pand tios,ph3oteingaeas,additinot ontoto buldi�gs oouide the ran other ionof SUFFOLK COUNTY, NEW YORK . ''
fi>� The a sstQnce of ngbt of ways and/or easements of record,rf any,not shown are 10!16101 SCALE: 1"=550' '
DESTIN G.GRAF l' SURVEY DATE:
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riot,•-�uararfteed: - 'v.
r '• ` CERTIFIED ONLY TO: =_.'
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` DESTIN G. GRAF , ' :;
AENSE.„r 000V �J LAND-SURVEYOR.'= : . - - '1.-2-L==,
4 ® SCHEMBRI HOMES
11.*��
,` v.. 73 Woodiavrn Road
VIII,P \'\' ,Rockffitint,NewYorli;11778 .>`
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63'1-821-3442 ^
By DESTlN G.GRAF N Y S.UC NO 50067 ^- .'` .
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