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Home My WebLink About1606-z FORM NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 1606 Z Date ...................... ~r.....9. ......... ~9~..1.... Permission is hereby granted to: ...... tlteh~ta~..l~ul~at ........................................ ...... 3.~...8.poone~...S.t .......................................... .......... Flor. a:L.P.~k~..l{, :[, .............................. to ....lhl~d.. new., On_e..f~m~ 1 y...cl~ell:Lug .................................................................................. at premises located et ....~.....I~;L~I~IDI~...~,t......0111~,],,~Cl) ...................................... ~ ...... ................................................. ~outholdt.....w.I. ........................................................................... pursuant to application dated ............................ N4~'ell~)e~. ....... ~, ....... 19.61.., and approved by the Building Inspector Fee $..'1 ~.OO ......... Building Inspector / SUFFOLK COUNTY DEPAR~'~NT OF HEALTH Riverhead,. New York ~A~plication for Approval to Cons~ruct Private Sewage DSsposal System_ TYPg OR PRINT ~GIBLY IN o To th~ S~folk County Department of Health Date ~.~ ~/- Application for Approval to construct orivate sewage disposal system is here ~ requested concerning which the following information is submitted: (a) Deed location of property ~wtz,.6,,'d. tz/,,.-:..,~','--,,., (b) Hamlet or Village 3. Cellar ~---q; 4. I,~ater Suppl~r Slab ,; Crawl Space~ .... '. (a) Pllbllc Syste~:: Earns Private %leli Distance to nearest main 5. Cesspools ~ I Co,. ~ ' ~a~ N'~r~er of po~ls -~- (b) Blocks below inlet (1). (c) Block size-L )~" in., (d) Precast pool !~ in. (e)No. of sections -'"' (f) Sq. feet per section Proposed System 6. Septic tank I (a) ~nsidelwidth___ft;(b)Lengtb_ . (c) Liquid depth 7. Seepage field (a) Trench - W in.; (b)L~ft. (c) N~mber of trenches , (d) Depth from bSttom of seepage pipe to ground water I here~y-certify that I am familiar ~ith the requirements of the latest bulletin of the "Standards for Private Sewage Disposal System" and will construct this system in co~_formance with these standards, or revisions thereof, prevsiling a~ the time of construction° "~, .,~,~/~.& ~.~t..~?~.~<7 .,~: '~-~--'~-"~ Applicant's Signature _ ~- ........................ :-~ ........ / ......... FOR USE OF HT_J~LTH DEPARTI.~NT OlaY Based on information presented hereon it is the opinmon of this Department that an adequate and satzsi~ctory sewage disposal system can be constructed on this plot, ~m / ~ -/..... Date Signature , .. ~. SCHD S-15 (Revis.) 4/61 Da'ca Test Hol~ Da~5 Ground Water Capa¢it~Oals. Ca'ac ity 3 G.P.M. Level // :~'xN x~///indicat e · Nor th Ftl 0 lO __ 12 --16 . 18 __ 20 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................ .~.~ ............ , ,9.l./......Permit No....r~...l....~...O......~.. ........ Disapproved a/c .............. ~.,,..... ................ .................... ................. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing Ioca¢ion of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property mast be drawn on the diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. gpon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progress of the work. e. No building shall be occupied or used in whole or in pa rt for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable lows, ordinances and regulations. /(s g. tuZ of app,,cant, or nw;,f ............................... ~;~;~.~.~.fi~;) ........................... ~- State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................... ..o.. ............................................................................ Name of owner of prem ses .~..I Ji.~.((]L.~. ! ..~.~ R .~. b O,...~.. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Location of land on which proposed work will be done. Map No: ....,.r...~...~ ........................ Lot No: ......... ~ .......... · , - . ./; ~'o.-. ~ ,'./ ,~ ,. Street and Number ..~.1..~...~....O...~.....~...Ii.~...~......~(.~...~.../4L'...C...~....~..a.......~....~...~..~ ........................................... .~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .............................. b. Intended use and occupancy 3. Nature of work (check which applicable): New Building .................. dition .................. Alteration Repair .................... ,~'emoval .................... Demolition .................... Other Work (Describe) ........................ 4. Estimated Cost ........... ."// .................. ~ .................. Fee .......................................................................................... (to be paid on filing this application) ,5. If dwelling, number of dwelling units ........ ..o....~'....~'. .......... Number of dwelling units on each floor ............................ If garage, number of cars ............... ~...o....~.[...~.. ............................................................................................................ 6. If business, commercial or mixed occupancy, specify natureand extent of each type of use ................................ 7. Dimensions of existing structures, if any: Front .......................... Rear .......................... Depth .............................. ! Height ..../.~. ................. Number of Stories .......... Q .~,/'.. ~ ............................... Dimensions of same structure with alterations or additions: Front ................................ Rear ................................ Depth ............................ Height ................................ Vumber of Stories .............. ~. ....................... ! D mens ons of ent're new construct on: Front.....~...~ Rear V ..... ;, ................... ..................... ............................... Height ...... ~...~. ................ Number of Stories .......... ..~.......~.....~. ......... 9. Size of lot: Front .......... /....~.....~.. .......... Rear ........ /.....0....O.. ........ Depth 10. Date of Purchase .......... ../-!,/.0....~......'~.......,~...~...~....C~....Name of Former Owner ........................ L), //~, ..~...1~, ..~......~......~./~/. 11. Zone or use district in which premises are situated ............................................................ 12. Does proposed construction violat,e any zoning law~ ordinance or regulation? ............ ~.....O... .............................. 13. Name of Owner of prem ses ~..'.t~..~./'.Z.u'....~...~.~..~/.Address .~....~...'~..~,~.~._O o .................... 7. ?~?&.}~.&-7~.~ .......................... Name of Architect ........... ~...4~.....~....~.~ ................... Address ............................................ Phone No ..................... Name of Contractor ......... ...'~....~..~..~....: ............... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. oo£e, o STATE OF NEW YORK, ) COUNTY OF ............................ ) S.S. ............... ~.,.../,....~...L'"./....~......~....../~..... ~.., .2~.~../. being duly sworn, depo~s and says that he is the applicant (Name of individual signing application) above named. He is the ....................................... .~,~ ............. L.~.~,..... ~J.~,~.~) .................... 4 .................................................... (Contractor, agent, corporat~ officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained.~~n are true to the best of his knowledge and belief; and that the work will b~formed in the ~~he application filed therewith. Sworn to before~this ~ ~/5o ~Ue~co~n~