HomeMy WebLinkAboutJLH Associates LLC i +
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ELIZABETH A.NEVILLE / A Q Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS N Southold, New York 11971
MARRIAGE OFFICER `� ��++ Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER = 0 i• Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER f�COUNri /8/'' 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. 3331 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : JLH ASSOCIATES LLC
Address 1: PO BOX 1925
City St Zip SOUTHOLD NY 11971
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 #R10-04-0057
blame Of Owner JLH ASSOCIATES LLC
Mailing Address 1 PO BOX 1925
City St Zip SOUTHOLD NY 11971
Property Address 1 315 ALBACORE DRIVE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 56.00 block 7 lot 14.000
Cross Street MAIN ROAD
Building Permit Number Cross Reference:
Issue Date: 7/08/05 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
WIF 1
SO//45, ,,y - I
' ELIZABETH A. NEVILLE s "'� t Town Hall, 53095 Main Road
TOWN CLERK ; illi , P.O. Box 1179
REGISTRAR OF VITAL STATISTICS gi cn Southold, New York 11971
MARRIAGE OFFICER Fax i0�1�, Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER 1..Ol. 4 �I1 Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER . C
OU southoldtown:northfork.net
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,'� - OFFICE OF THE TOWN CLERK
Llt. JUN26 j `" TOWN OF SOUTHOLD
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- Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: June 6, 2005
Transmitted herewith is a copy of application No. 3474 for a Cesspool/Septic Tank Construction
Permit submitted by:
JLH Associates, LLC
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:.
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717/4..../.,Z20/' .
Signatu e ' - .:
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9 t e d
1111, *
, . ELIZABETH A. NEVILLE l4, V
Town Hall, 53095 Main Road
TOWN CLERK ; P.O.Box 1179
Z Southold New York 11971
REGISTRAR,OF VITAL STATISTICS v Af '
MARRIAGE OFFICER O �� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER "-.4+ O.'�.0 Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER . *''�a••• 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 @ $25 Application No. 341
Permit No.
Applicant Name -J H A 5 5c) C I Akre-5 LL C
Applicant Mailing Address P-0, /07'' f fd-S
Sod 1toc-01 U Y. ) ( 7 / .
Septic Tank or Cesspool
Brief Description of Proposed Construction or Alteration /U(st✓ 01/d FAA /L Y
L( 5-10 tswc<'
Location of Proposed Construction/Alteration:
Owner of Property: 0- ` N ,kS SOC ( I'W5, L L C" •
/
Owner Mailing Address: 1' •U . 60'6 / 2.5-
SST/i0L-O / /1. � )( 7 /
Owner Property Address Is ALBAcoitd 1)A,r/((
souwo c_o / 1,/, . 0 7/
Name and phone number of contact person 5) H "X 7Aco v .5 5 3 - `t3/
,. , Tax Map No: Section -s Jo Block O 7 Lot 77'
Cross Street t4 4//4 4 b ( /1 l 2$)
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WI HE TH DEPARTMENTAPPROVAL
----ba,AA. gnature of Applicant Date
Received by: `•
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' ' •I TY DEPARTMENT OF HEALTH SERVICES PERMIT FOR APPPt0't�A10 +'CONSTRUCTION p'pR A Rf CEt VEO
+ Sanitary system must be installed exactly as proposed. SINGLE FAMILY RESIDENCE ONLY �FC
LK N ; Invert elevations must match proposal on grading plan. D TEJUN*0 2 2005 � ' � `
• ,Istem is no to be installed lower due to seasonally lower i3s •. 0�� -� JUN„�
groundwater. Elevations to be certified by engineer or ro � APPROVED _ �� 32
$Ulveyor. Certification to be submitted with final paperwork ..� N - 1 AI
Q-14:00:04.04114,c--:0,..::: - __-_-.FOR IMtrM OF eEDRO(h4I.� �' BEY OF PROPERTY
NOTE, • ��° 3 ?' EXPIRES �,r f T��t
THREE YEARS FROM DATE OF APPR A A R5'HA MO1f8t A 0 U {
SYSUBSURFACE SEWAGE DISPOSAL ` - rfOVAL
ay,
STEJOSEPH FISCHETTI, P.E. 4 `� R d II N VR ovv L OLD
H'OBART ROAD � �,
S`OUTHOLD, //97/ • 4 `` �'��' SUFFOLK l OLK COUNTY, N. Y.
• (63/) 7652954h„ 1000-56-07-14 i
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' ' ENGN'iEER's CERTIFICATIOM REQUIRED. MARCH 18, 2044
4QTi rV �� �. U13I1�17`P.E OR R>A. CERTIFICATCA SEPT. 07, 2004 (ROOF DRYWEI.LS)
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'�c� k CONSTRUCTION DEC. 20, 2004 t CERTIFIED!
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,x i, ,, '-', e� / ,d CERTIFIED TO '
A ,;t n sie��y I am familiar with the STANDARDS FOR APPROVAL JLH ASSOCIATES LLC
o/i \ AND CONSTRUCTION OF SUBSURFACE SEWAGE STATE TITLE AGENCY, INC.
k DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES STATE BATING �' L.I.
P�nee '4j►'T Fc. ,y and will abide by the conditions set forth therein and on the
�•a. permit to construct.
am Iheil Q../S.t
1 --1- -�_. r The location of wells and cesspools shown hereon ore
�OF Ne4/
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'F 1'� PROtOSED SEWAGE DISPOSAL from field observations and orfromdata obtained from others. '� y -
- � b � SYSTEM 6 POOL S 2' DEEP NOTE= \ ,;(3"6�N'f.MEI,. 04t
WITH 3' CLEAN SAND COLLAR ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION 'O ,
'I 6' BELOW FOOLS 1500 tau SUBSURFACE SEWAGE DISPOSAL -: COON 7209 OF THE NEW YORK STATE EDUCATION LAW.
(- PRECAST CONCRETE is SYSTEM DESIGN d RETAINING WALL
Mr° TANK BOTTOXI OF LEACHING E TAS PER SECTION 7209-SUBDIVISION 2. ALL CERTIFICATIONS * I` �"k i
e POOLS TO BE 2'ABOVE DESIGN BY' HON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF _1>
EL.-43 CROWWATEA JOSEPH FISCHET Tl, P.E. SAS' MAP OR COPIES BEAR. THE IMPRESSED SEAL OF THE SURVEYOR' /
CRO.SSFCTION HOBART ROAD *HOSE SIGNATURE APPEARS HEREON. �~ / ��� N. IC q�' 4
SEPTIC SYSTEM. souTHOLD, N.Y. 11971 'ECONIC • �� YOBS, . ���;��'
(63/) 765 - 2954 I e T NI!URA-RC RFFFR TO "AAA P OF SC)/I TNn!r) S!4(RFC" /c 111 ?Cr cn07n C v /c 1" •' -- .7
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