Loading...
HomeMy WebLinkAboutJSC Resources Inc �osuFFOL4 ELIZABETH A.NEVILLE ;/40 O • • G�� Town Hall, 53095 Main Road TOWN CLERK o P.O. Box 1179 ti z ; Southold,New York 11971 REGISTRAR OF VITAL STATISTICS $ MARRIAGE OFFICER ` Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER �y_�Ql $��i��, Fax (631) 765-1800 FREEDOM OF INFORMATION OFFICER ,��� southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 3233 R Residential X Non-Residential Fee $ 10.00 Septic X Cesspool PERMIT ISSUED TO: Name : JSC RESOURCES INC Address 1: PO BOX 1551 City St Zip QUOGUE NY 11959 Descripton of Proposed Construction or Alteration SANITARY SYSTEM FOR ONE FAMILY DWELLING. APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES. REF #R10-00-0133 Name Of Owner JSC RESOURCES INC Mailing Address 1 PO BOX 1551 City St Zip QUOGUE NY 11959 Property Address 1 3190 HAYWATERS ROAD City St Zip CUTCHOGUE NY 11935 Tax Map No. section 111.00 block 11 lot 13.000 Cross Street VANSTON ROAD Building Permit Number Cross Reference: Issue Date: 10/01/04 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) • ,,�,oio0,9 • sufFout- 3A,3_3 ELIZABETH A.NEVILLE �� 1d Town Hall, 53095 Main Road TOWN CLERK P.O. Box 1179 W Southold, New York 11971 REGISTRAR OF VITAL STATISTICS G ** MARRIAGE OFFICER 4, �� Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER �_�OlJig .0 ��� Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER �,,•��� southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SEP 2 I iii F TO: Southold Town Building Department FROM: Linda J. Cooper, Southold Town Clerk's Office DATED: September 20, 2004 Transmitted herewith is a copy of application No. 3375 for a Cesspool/Septic Tank Construction Permit submitted by: JSC Resources,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: RECEIVED d4.6e Signature Flo c2. 3 r__ 2-2. .3 Southold Town Berk Dated „I�,�o��sUFFO(,ree ELIZABETH A. NEVILLE � l .y• Town Hall, 53095 Main Road ` TOWN CLERK p d • P.O. Box 1179 REGISTRAR OF VITAL STATISTICS ti Z Southold, New York 11971 MARRIAGE OFFICER 11971‘`lb .F�� Fax (631) 765-6145 RECORDS MANAGEMENT OFFICERf� s164 ` � Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER = •/ * ,,. southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANK Residential @ $10 ✓ or Non-Residential @ $25 Application No. 337-s” Permit No. Applicant Name TSC• .S Applicant Mailing Address ' do, /j-r, 4,L,4.11s4.._ /Y Y // fr / Septic Tank V or Cesspool Brief Description of Proposed Construction or Alteration 5/%y4 F4:44,14/10-4.1„....) A. 41/ ,0f( 2 Location of Proposed Construction/Alteration: Owner of Property: J.S� s'G'- v c.. y�it - Owner Mailing Address: ,ga J7 4‘214,9 Y Owner Property Address: 3I/iiy 4,,ti044. .s 141/749/004.• "70 Name and phone number of contact person J I1141/�J / Z r =.-t. • Tax Map No: Section /1/ Block /1 Lot D/J Cross Street V4451744.4-- NOTE: 44S' —NOTE: LOCATION MAP MUST BE SU,B► ITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVEY ' H H"ALTH DEPARTMENT APPROVAL 7/20/0_Y � S _ .ture of �hcant Received by: r' SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES 1 FOR OFFICE USE ONLY OFFICE OF WASTE WATER MANAGEMENT ' ' SUFFOLK COUNTY CENTER-RIVERHEAD,NY 11901 Health ll9arhnent Ref.No. (631)852-2100 I 1. IC —00 © 13 3 APPLICATION FOR EXTENSION,RENEWAL OR TRANSFER OF EXISTING PERMIT TO CONSTRUCT SEWAGE DISPOSAL AND WATER SUPPLY FACILITIES FOR SINGLE FAMILY DWELLING REFER TO REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS PLEASE TYPE OR PRINT LEGIBLY • EXISTING REFERENCE NUMBER Det 1.4t. Block Lot Tax Map No. 10Qo- lY I - 11. I 13 NAME Q.F.,APPLICANT .44:52.- �t ^4'1 s . e4- � ►'�+ +1') (If name is different from original applicant,see instructions for transferring a.- 't and complete tion 6 below.) Mailing Address j t 4,. 4 •-. 1 C-1 ,.,I Phone 2i,Z ZZ 6,3 z NAME OF AGENT(If not applicant) V�(�t �1 lith-�o�l.�e . - Mailing Address ,a f jam- (a (� ,it1 Ni 1 Phone 4,3 i _134,.4,4 ,E DATE OF ORIGINAL APPROVAL iii '/ O t! 7 / (If more than 6 yearsld,a new application will be required.) TRANSFER OF PERMIT:I hereby transfer all rights and interest in the above referenced permit to the new applicant named above; SIGNATURE OF ORIGINAL PERMIT HOLDER/AGENT PRINT NAME DATE MAILING ADDRESS PHONE Application is herebye 61 1 extra ]renew,[ ]transfer for a permit to construct in accordance with this application, surveys and plans s tted. I hereby 'fy that I have examined this complete application and the statements therein are true and if correct,and that all ork shall be done i accordance with all applicable Town,County,State and Federal Laws. "Any false statement made h ein is Punishable as a demeanor ursuant to S210.45 of New York State Penal Law." Signature of ‘ P.. . Date . Print`Name ofApplicant ��`l Title _ VOLIt1rt' /110_Y_7 11V4— If you are making Substantial revisions or modifications to a project that has already received a permit to construct from the Department,or it the permit is more than six(6)years old,a new application will be required. Renewed permits are subject to any changes in standards enacted after the approval date of the original permit. DEPARTMENT USE ONLY Permit is Extended/Renewed/Transferred Until -- F-06. N r of Bedrooms Approved 1 / r Signature of Department Representative f Date tO—7-C33 WWM-104(Rev.3/03) Page 1 of 2 0. t' C I q��jNCT , O N/F POSNER N N�0 LOT 410 p 16•S3, VACANT LAND ,jo., TEST HOLE DATA 4 APRIL, 2000 SURVEY OF PROPOSED c N 50%EXPANSION ` PERFORMED BY: McOOAI4LD cEosaENCE LOTS 411& 412 IN p , (` PROPOSED I ,� Ewsnwc GRADE MAP OF SECTION 0 PROPOSED` SEPTIC•TAN� �SS �����.��• FD a O �' NASSAU POINT CLUB PROPERTIES, INC. t+'1 Cm CES,58DOL� --- 'V O CQ' �/ J' aurrSaawSANDY caul a SITUATE I n_ ,v/ �� saw LOAMY MAO Ski p / GABA n I UNDER —2s NASSAU POINT PROPOSED I / SUFFOLK COUNON Y. / '''.j. PAIL BROW n.[10 CONKS FMO Sw g 3 BED 00 t L.. SURVEYED FOR: LISA K. KIRSCH l RES'D£`lCE l 0 HER TZEL ABRAHAM eon UMti V / / / • ` nM 1000-111-11-13 VPOLE lb4',. '.so. FM!806 N/F LEHMANN / / O FILED MAY Z 1926 RESIDENCE '1 \ / �� �' SURVEYED MARCH, 2000 j� / / v O SCALE 1'=40' 1 • FOR S.C.D.H.S. USE ONLY AREA= 39,026.64 SF i� / / / / N'L O 0.896 ACRES 2 I / / / �0Q SUFFOLK cowry DEPARTMENT OF HEALTH SERV: GUARANTEED TO O o/ / RESIDENCE USA L. KIRSCH I / PERMIT FOR APPROVAL OF CONSTRUCTION R A HERTZEL ABRAHAM / SINGLE FAMILY RESIDENCE ONLY / �\'" ,CV / DATE -1'L8' HS REF.NO. R Co-oO—• ., ( / �� wt�t A -,' -' D R— an f p / / h�L.� E7P(RLS THREE CIM YEARS FI DAYEOFAPPROVAL ELEVATIONS TAKEN FROM / 5 / • EAST END TOPOGRAPHIC MAPS J Um ON FILE THE SUFFOILK COUNTY / POLE ON OF PUBLIC WORKS / / / �, PLEASE NOTE / / w Minimum distance between well / .� c.-..,4„1,4%. ONLY TO F SHALL E "Y are' - pool is to be 150 feet. r^;.CI` IS PREPARED,AID ON HIS BEHALF 70 DIE FD / / . MILE COMPANY,GOVERNMENTAL AGENCY, N LENDING NIST/TUTkW,F USTED HEREIS AND A..! TO THE ASSIGNEES Or A#L£MpNG WSATt.'DON. • �,Yp�-{�. GUARANTEES ARE NOT TRANSFERABLE TO ' '• 9 y� 6 / /`• ADDITIONAL INSTITUTIONS OR SLBSEWEHT DINERS. SURVEYED BY e0'" ,9 S3• V TAN EY J. ISAKSEN, JR. T e •0 33 n UNAUTHORIZED ALTERATION OR ADDITION TD THIS -' O RESIDENCE SURVEY IS A MOLATTON OF sEcTiow 7209 OFP.O. :OX 294 ti THE NEW mac STATE EDUCATION LAW. NEW • FFO_K NY 11956 N., i 11/ fro 6CLI 3 G ��``s %. THE LANCOPES D SURVEYORS MIS EM'AP oss OTSEAAL SHALL ..;:ii..1 . / / 1ARING ' LOT 413 NOT BE CONSIDERED To BE A VALID TRUE CELL '%�SSu�/ !/ e COPY NYSNS 7NOND9SU' . OR RESIDENCE 1 RESIDENCE , 00C. 95