HomeMy WebLinkAboutJSC Resources, Inc TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MA.RPJAGE OFFICER
RECORDS 1ViANAG~T OFFICEP~
FREEDOM OF INFORMATION OFFICER
Town I-I~]l, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
sou~holdt own.nor thfork.net
OFFICE OF TI-I~ TOWN CLERK
~ TOWN OF SOUTHOLD
:. SEP 2'[ 20 4 .i
~ TO:,- Southold Tox¢~ Building Department
FKOM: Linda J. Cooper, Southold To~vn Clerk's Office
DATED: September 20, 2004
Transmitted herewith is a copy of application No. 3375
Permit submitted by:
for a Cesspool/Septic Tank Construction
JSC Resources, Inc~.
Please review the applicati.'on and location map and adx4se ii'the project has received Suffolk County
Health Department approval and if this office may issue the permit.
Please complete the form below and remm it to me.
Linda J. Cooper
I have reviewed the application and location map of the project cited above and make the following
reconmlendations: ~
APPROVI~
DISAPPROVE
Comments:
Dated
E~ETH A. NEVILLE
TOWN CLEItJ~
REGISTtt~q OF VITAJ~ STATISTICS
MARRIAGE OFFICER
RECORDS IViA~AGEMENT OFFICER
FREEDOM OF INFOILM-~-TION OFFICER
Tovrn Hall, 53095 Main Road
P.O. Box 1179
Sou~hold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southold~own.nbrthfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD ~VASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential ~ $10 /or Non-Residential ~ $25 __
Application No. D 3 7 ''-x'~
Permit No.
Applicant Name ~7~'~'~- ~__lg-S~.~"~-~--., ~
Applicant Mailing Address ~. ~
Septic T~ ~or Cesspool
Brief Description of Proposed Cons~ction or Alteration
~cation of Proposed Cons~cfio~teration:
Ox~erMai~gAd~ess: ~ ~
Om~ Prope~ Ad'ess: ~/
Name'~d phone number of conta~ person
Tax Map No: Section
Cross Street
NOTE: LOCATION I~kP MUST BE SU~
CONSTRUCTION REQUIRES SURVEY~
Received b'y:
Block // Lot ~/.~
~TTED ~VITH APPLICATION. NEW
~f/ALTH OEP ARTf~IENT AP PROV AL
~5'~ic ant -' .8~ate
APPLICATION FOR EXTENSION, RENEWAL OR TRANSFER
OF. EXISTE~G PERMIT TO CONSTRUCT SEWAGE DISPOSAL
.ad~D WATER SUPPLY FACILITIES FOR SINGLE FAMILY DWELLING
£
- -- .iooo ~ ~:t~ II. 13
WWlVI.104 (R~v. 3/0~)
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