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SCLITHCLD VIASTEVIATER D SP08AL PERM T
OCNSTF(CTI CN CR ALTERATI CN PERM T
SEPTI C TANK or CESSPOOL
Per nit ND. 4267 R Fbsi dent i al X Nin-Fbsi dent i al
Fee $ 10. 00 Septic X Cesspool
PERM T ISSUED TO
Name : J NS CCNTRACTI N3 LLC
Address 1: P O BCt( 385
City St Zip WEI NG RI VER NY 11792
Descr i pt on of Proposed Const r uct i on or Al t er at i on
SAN TARP SYSTEM FCR SI NCIE FAM LY WELLING
APPR)IED AS SLUM TIED AND AS APPRCWED BY THE SLFFCLK CCUYFY DEPARTMENT
CF HEALTH SERA CES Fl NAL APPRD✓AL REQJ FED FROM THE SIFFCLK CCUVfY
I- 4LTH DEPARTMENT. REF #R10- 14-0067
%me a Canner JOHN ZQ..M S
Mai Ii ng Address 1 2050 N CCUVTRY ROAD
Ci ty St Zi p WCI NG R VER NY 11792
Property Address 1 3585 CFFAT PECCN C BAY
City St Zip LAIFEL NY 11948
Tax Map No. section 128. 00 bl ock 3 I of 12. 005
Cr oss Street DELMaR DRI VE
Bui I di ng Per nit Number a oss Ref er ence:
Issue Cate: 10/ 10/ 14 Elizabeth A NeviIIe
Sout hol d Town a er k
(TON SEAL)
,r,
•� , ,o� gUFFO[,��0 ,
ELIZABETH A.NEVILLE,MMC i�� l/y Town Hall,53095 Main Road
TOWN CLERK p P.O.Box 1179
y Z Southold,New York 11971
REGISTRAR OF VITAL STATISTICS ,'t' r ��
O � Fax(631)765-6145
MARRIAGE OFFICER `• y,� ��'er Telephone(631)765-1800
FREEDOM ORECORDS F INFORMATION OFFICER AGEMENT OFFICERO! -0„.0www•southoldtownny.gov
OFFICE OF THE TOWN CLERK. 1
TOWN OF SOUTHOLD
TO: Southold Town Building Department L, SEP 2 9 2014
FROM: Sabrina Born, Southold Town Clerk's Office {
DATED: September 29, 2014
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4267 for a Cesspool/Septic Tank Construction
Permit submitted by:
JNS Contracting LLC
Please review the application and location map and advise if this office may issue the permit.
Please complete the form below and return it to me. Thank you.
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments: Final approval required from the Suffolk County Health Department
,/67 -
Signature p
/42 d i
Dated
ELIZABETH A.NEVILLE `1� �Gy�` Town Hall, 53095 Main Road
TOWN CLERK p P.O. Box 1179
V3 Z $ Southold, New York 11971
REGISTRAR OF VITAL STATISTICS V. nt
MARRIAGE OFFICER
O .tC �� Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER %%4'u ,ty og Telephone(631) 765-1800
-
FREEDOM OF INFORMATION OFFICER 4iiii ,�'i southoldtown.northfork.net
''00
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. y 26 7
Permit No.
Applicant Name 3-1%-)S t T C...tA--i' LLC_
Applicant Mailing Address go %D,i, rsg,c-- v .\..,\)-- - i.)1 I`,i +
Septic Tank ,/or Cesspool
Brief Description of Proposed Construction or Alteration lv e- -) 5'c•4c.- C",--i-^A-1 �e(
Location of Proposed Construction/Alteration:
Owner of Property: '5' 'Lr‘ 2 -'
Owner Mailing Address: , . C.,,, G
u- r� Q Is1 l\-1‘ ,
Owner Property Address: SNv-‘ <— �D
3 58 &02-0:.t / -ec,0 ri C: y, 0-vr 4
Name and phone number of contact person -� yam -. r -cco'v r / 1 c�-Q-SS(2)cam
Tax Map No: Sectionti- tc Block S Lot ��..5
Cross Street i'--\‘\"—I Vcvt-
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY TH HE• TH D PARTMENT APPROVAL
_ :_aprif - 4 la9/1y,
ure of Applicant Date
II--
Received by: I dr
l
. _
. ,
PROPOSED DWELL 2.380 SQ. FT. W/4 BEDROOMS
LOT AREA = 20,922 SO. FT.
SANITARY SYSTEM 1000 GALLON SEPTIC TANK, 1 LEACHING POOL 8'DIA. X 12' DEEP
CAR ELEV. .-- 24.0 I
FEL ELEV. = 26.0 ( ) ELEVATIONS -
I
NOTE DATUM NAVE) 1988 ' I
1
I
1
.---\----- 1,
DWELLING / PUBLIC WATER
I:
NOW OR FORMERLY MYRON YOUNG
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,
-0 co ,... WELL 4.
ts' C
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GAR
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o --I 1
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L=46.97'
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as (22.7) k 1 1 (2"11)41201 122.56'
S 28'37'00W 153.00' ,
I'
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PECONIC BAY BOULEVARD (214) 1
/ .
DWELLINGS PUBLIC WATER
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,
:
i
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
PERMIT FOR APPROVAL OF CONSTRUCTION FOR A
SINGLE FAMILY RESIDENCE ONLY
RECEIVED 1
7 '
DATE S'/00 i H.S. REF No kZ,10-11- (Dto i
I
JUL 30 2014
' APPROVED Alk„...............L., ' 4,44,C-••42.-
SUFF.CO.HEALTH SERVICES FOR MAXIMUM OF BEDROOMS
OFFICE_OF WASTEWATER MGT. WIRES THREE YEARS FROM DATE OF APPROVAL
NOTE:
Location of water mains
& adjoiners water supply
HE OFFSETS(OR ONSONNOTTE)SENN MON FROM NE SONOTORES TO The 1
by others and are not
POoPeTry togs Fie FOR A SPECIFC. PURPOSE FAO USE AND THEREFORE NW NOT J08 No. 14_130 ALE No. 959 F
guaranteed. oottioco To owe Time ESECRON Of FENCES,AMMO IOUS.Mot&FROM
KAMM Mee. OFEESOCN TO SOUNNOS OR NTT ORM oewsowerioN.
SURVEYED FOR *MOOS ZOUMAS
~MR=AtnekTER4 OR*MOW TO The Weer O A VIOLATION°F 11831°4 KNOWN AS LOT NUMBER 2 MINOR SUBDIVISION
7200 or THE NEW YORK SEM EINTEVOION LAN.
MAP FOR CECIL T. YOUNG
O(MRANTEES TEST HOLE BY McDONALD GEOSCIENCE is "Irswerrnle,Yrrt en no S4ML"4 ro;4:0
in1HE
t""4,"'''wm'm THE SITUATED AT LAUREL
40194OT AND LER*ISSERWOON USITIVITEREON.N 10 11€ISSENISES OF THE
ELEV=22.6 7-10-2014 1DC°41 INOTOOTITh4.- °The°°163*11E 14°T TheOnteler TO 4001°01"setnwnote , TOWN OF SOUTHOLD, SUFFOLK COUNTY, N.Y.
OR SIASEEMOTT MOM
DARK BROWN LOAM OL .
SCALE 1 = 40' DATE 7-8-2014
toms or The WOO NAP 1407 SEFFOTO Tie We SUIMAIRI Nee SEAL OR
EMBOSSED SEM. STOLL NOT OE CONSTODIES TO le A WEJO Tee MK
-r- FILED MAP No. DATE
BROWN SILTY SAND SM CERTIFIED ONLY TO: TAX MAP No. (REF ONLY) 1000-128-3-12.5 DISK 2014
2.5'
PALE BROWN FINE SAND SP HAROLD F. TRANCHON JR. P.C.
LA ND SURVEYOR
P.O. BOX 616
17'
NO WATER ENCOUNTERED - F---7-. i
14,Y. L . No. 048992 1866 WADING RIVER-MANOR RD. WADING RIVER,
NEW YORK, 11792
i (9--' 631-929-4695
HAROLD F. TRANCHON JR. PENN. UC. No. 2115-E