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Home My WebLink AboutJLC Management Inc (2) • �,,O*pF SO(i4 ELIZABETH A. NEVILLE e A Q Town Hall, 53095 Main Road TOWN CLERK # All'; P.O. Box 1179 REGISTRAR OF VITAL STATISTICS co Southold, New York 11971 MARRIAGE OFFICER � 1 Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER Tele hone (631) 765-1800 FREEDOM OF INFORMATION OFFICER °O it‘ .1°� southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 4288-R Residential X Non-Residential Fee $ 10.00 New X Existing Name Of Owner J L C MANAGEMENT INC Mailing Address 1 7 BRADLEY LANE Mailing Address 2 City St Zip EAST MORICHES NY 11940-0000 Property Address 1 NORTH ROAD Property Address 2 City St Zip GREENPORT NY 11944-0000 Owner Telephone No. 631-878-7077 Tax Map No. section 40.00 block 3 lot 3.002 Cross Street QUEENS STREET Issue Date: 8/05/05 Elizabeth A. Neville - Southold Town Clerk (TOWN SEAL) - " So c --k v 1 d To cam-, Cl e,--k ELIZABETH A.NEVILLE ��h`` 4 ; Town Hall,53095 Main Road TOWN CLERK .d % P.O.Box 1179 REGISTRAR OF VITAL STATISTICS ; Southold, New York 11971 MARRIAGE OFFICER -: O I� Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER y Ov oe Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER el * 4:00 southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION OPERATION PERMIT CESSPOOL or SEPTIC TANK Residential @$10 ../ or Non-Residential @ $25 Application No.`1254 Permit No. 3 3 2 Zeri - Owner Name 3. I--C M Co-)a e 4, I h C Owner Mailing Address 7 8 r cZ I e y Lo r e eas-)- 04-'C_I-)cs Ny 1 ! )4 Owner Property Address O r-44-) R 0 CLCI c C_h or 4- I fes/ I I L4 L Owner Telephone No. 31l 8 7 8 7 O7 7 „Gr--- Tax Map No: Section -J 0 Block -3 Lot .' 2 Cross Street CIL) C er)5 5-l-r-c e-+ Please check each that applies: New Construction `/ Alteration to Existing System Residential ✓ Non-Residential NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. (Locate building and system; give north arrow and approximate distance in feet from system to building and closest road. New construction may submit copy of survey with SCHD approval.) LUA,Q- CCOvIl ,,, 1/P 7 -25 -65- Signature of Applic.d Date Received by: 1,tf. SOU: _ ELIZABETH A. NEVILLE (� ez 4 Town Hall, 53095 Main Road TOWN CLERK * *, P.O. Box 1179 REGISTRAR OF VITAL STATISTICS c/+ Southold, New York 11971 MARRIAGE OFFICER �` i� , Fax (631) 765-6145 RECORDS MANAGEMENT OFFICER Telephone(631) 765-1800 y � p 1 FREEDOM OF INFORMATION OFFICER = COUNI15 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. 3322 R Residential X Non-Residential Fee $ 10.00 Septic X Cesspool PERMIT ISSUED TO: Name : JLC MANAGEMENT INC Address 1: 7 BRADLEY LANE City St Zip EAST MORICHES NY 11940 Descripton of Proposed Construction or Alteration SANITARY SYSTEM FOR SINGTF FAMILY DWELLING. APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES. REF #R10-05-0032 Name Of Owner FRANCISCO, A L R Mailing Address 1 7 BRADLEY LANE City St Zip EAST MORICHES NY 11940 Property Address 1 NORTH ROAD City St Zip GREENPORT NY 11944 Tax Map No. section 40.00 block 3 lot 3.002 Cross Street QUEENS STREET Building Permit Ntmber Cross Reference: .q.21/4 411 issue Date: 7/08/05 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) �� ,�OeQF SOU/4o ELIZABETH A. NEVILLE s lQ Town Hall, 53095 Main Road TOWN CLERK * *% P.O. Box 1179 REGISTRAR OF VITAL STATISTICS Southold, New York 11971 MARRIAGE OFFICER Q 1 Fax (631) 765-6145 RECORDS MANAGEMENT OFFICER ..t q, ��,/ Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER = COUNT C.I southoldtown.northfork.net '•_ ,, •'s OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD July 11, 2005 JLC Management Inc 7 Bradley Lane East Moriches,NY 11940 RE: SCTM#40-3-3.2 Dear Sir/Madam: Enclosed herewith is the Construction, Alteration or Modification Permit for a Septic Tank/Cesspool System for which you applied. AFTER the system is installed but prior to being used, an OPERATION PERMIT IS REQUIRED. The operation Permit is issued by the Southold Town Clerk's Office. The fee is Ten Dollars ($10.00) for a residential system and twenty-five dollars ($25.00) for a non- residential system. Your check should be made payable to the "Southold Town Clerk". An application form is enclosed. Please complete the requested information and return the application, proper fee, and LOCATION MAP (map must indicate the location of the cesspool(s)/septic tank(s), giving approximate distances in feet from any buildings to the pools and distances between the pools. Should you have any questions concerning this matter, please do not hesitate to contact this office. Very truly yours, Lynda M Bohn Account Clerk Enclosures