The URL can be used to link to this page

Home My WebLink About3699-zNO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. ~....~...0.~.~ ............. Date ................. ~/'. ...... ~1., .................. , 19..~J~. THIS CERTIFIES that the building located at ~...~t./~l~..~'J~...~.~.Q~ ...................... Street Map No ....................... Block No ....................... Lot No.&..A:~JLJ~t~...~:~.$.~.e,...~.~.~,.,...J~.e'~...~.~.~ conforms substantially to the Application for Building Permit heretofore filed in this office dated .............................. I~.~...[~. ................. , 19...~. pursuant to which Building Permit No. dated ................... ~.,...~.1~, ................ , 19..(~.., was issued, and conforms to all of the requirements of the applicable provisions of the Iow. The occupancy for which this certificate is issued is ........ ..P.~ ~.?_a..~ .e....9..n...e....~ ..am .& ~...~.~ ;[.~.. ,...~v.~ .. ~.n~..~ar...a~e~..g~e .................. The certificate is issued to ......~g.~..t;....o.0~.O~'.l~le.,....~e~., ............................................................. (owner, lessee or tenant) Building Inspector ~,' TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD~ N. Y. BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3699 Z Permission is hereby granted to: ............... lJ.~..~f~.~Jxe~e .................................... to ~.1 .~...~.~....*.~..~.~.~,~,y...d.~.t~,~ .............................................. i.il ............ at premises located at ..~.~...A1~'~...~../~x~J~.~...~. ........................ i ........................ ; .................. pursuan[t to applicdtion dbted ...................... Q~t~ ....... ~J~.... ............... , 19.~..., and approved by the Building Inspector. Building In;pector / TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y. NOTICE OF DISAPPROVAL File .No .................................................................. Date ............................ .0.?.,.~,,O.k~ ....~8. ....... 19...6.~., .......... 25~ ....Draft allt ..A~e ................................... ................. ~.......~a.~,~h.o..g~;.¢;. ..... }!.:%: .................... PLEASE TAKE NOTICE that your application dated ................... .0...e..~ ........ 4..8. .......... 19...67. !or permit to construct ..L.~:¢.~I,];~Dg ....... at thc premises located at ....~,~..'.¥'.~..,.4Y..q.,,.&.. .... ........ A..~..D..o.....~...2.y.¢. ....................................... Street L~re3,~ 'L.,,, Map ......... ~ ......................... Brock ......... ~2&X. ..................... Lot .................... ,~tY~ ....................... is returned herewith and disapproved on the following ground~ ........................................................ · . AIo.'M ;k ~.t,~.:p.t..;;;o.,.,...¢~g,~.,,.~. ~..;:..~o..,,,.a~iae.&,,, ........................... Ho~d~,;t .~.&~e~.S .~. f.ce for corrected a~p.,lie~tion. Building Ihspector { S-9 SC~D SUFFOLK COUNTY DEPARTMENT OF }~ALTH Bldg. Permit No. The sewage disposal facilities for a structure located at (Give deed location) have been inspected by this Department and found to be satisfactory. District Engineer " Distric'~ Engineer SUFFOLK COUNTY DEPARTMENT OF HEALTH . EASTERN DISTRICT,RIVERHEAD,N.Y. APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Date Approval to construct said systems is requested,pertinent data herewith: 1-Applicant ~'~ ~/~ ~ Phone~$?-~mm-,., 6-Sub div Address 7-Section ' ' t3~ /~ L~ ~ .... S-Lot No. 2-Detailed pro~oerty locat,ion J/~o~ ~ 6 ' ~c6o ~fOu~, £.A~-. 3-Public water supply name Distance to nearest main k-Lot size: Length 0~_ft. Width/F7 ft. (Also enter on center plot plan below:) 5-Dwelling: ~n~l~ ¢~mf]v?/~/Two famfly?/ /Cellar?/~/Slab?~__~Crawl Space?/ 10-Proposed system:Septic tank~/Precast/~--~Cesspools~/Shallow-peols/ /oth r/ il-Septic tank inside dimensions:Volume Gals.Length Ft.Width ft.Liquid depth ....... ft. 12-Precast sections :/J,/Number.//~Square" ft .Cesspools :Block siz~¢~ins .D ~ ins.H ~' ins. H. D. Reference No. f/~8 PIAN Street /0o4- Capacity~Gals y- Test Hole Data Feet O 2 6 lO 16 The Undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Health Departments' current Standards,Bulletins, and amendments thereto,covering Private Sewage .Disposal SysCO./'..~ D&te ...... Signed Owner or Builder FOR HEALTH DEPA&T~ZNT USE ONLY. Based on the information presented herewith,it is the opinion of the Health Department,that an adequate and satisfactory Sewage Dispgsal System can be installed on this Plot. Date ~,~ ,/~? Signed 10/65 East APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS INSTRUCTIONS: Applications must be submitted in triplicate 1-Means Owner or Builder. Address to which mail should be directed. 2-Means detailed description of property location, together with street name and distance to nearest intersection of main thorofare, also Hamlet/Village & Township 3-Enter name of Public Water Supply District, together with the distance to their main. ·-Enter Length and Width of Lot under appropriate heading, also enter these dimensions on center plot plan shown on the face of this application. 5-Dwellings: Check-mark "V" items applicable to the proposed new dwelling. 6-Name of sub-division ?-Section Number 8-Lot Number 9-Private well: Ente~ "No" if Public water supply is available. Enter "Yes" otherwise. PROPOSED SYSTEMS: Answers to Items number 10, 11, & 12 please consult the Suffolk County Health Department's Standards, Bulletins and Amendments for Sewage & Waste Disposal Facilities. i.e., Part II-Residential Sub-surface Disposal Systems ?vering Cesspools Part III " " " " " " Septic Tanks Part IV " " " " " " Unusual soil conditions Part V " " " " " " Shallow Leaching Pools PLOT PLAN: The following information is required concerning the Applicant's Lot: Lot size-Length and Width in feet to be indicated at the Lot lines of the heavy lined square in the center of Plot Plan shown on face of this application. Surface waters-Streams, Lakes, & Bays, etc., located within a distance of 50 feet of Applicant's Lot lines, must be shown on the plot plan also. Wells and Cesspools now on adjacent lots must be shown on the Plot Plan together with the distance to the Applicants proposed Sewage Disposal Systems and Well. Where no Buildings exist on adjacent lots, state "Vacant" on the plot plan. Streets adjoining applicant's lot to the right, left or rear, enter street name. WELL LOCATION: To locate the well & seWage disposal systems on Applicant's lot, the following Standards must be observed: Well-100 feet minimum distance from the nearest cesspools Well-25 feet minimum distance from rear, and rear sides of property lines Well-lO feet minimum distance from front, and front sides of property lines Well-50 feet minimum below grade for well point Well-40 feet minimum into ground water for well point Well-4 feet 6 ins. minimumbelow grade to well head and lateral water pipe C_~ESSPOOLS LOCATION: Upon determination of the Sewage & Waste disposal "type of systems" required, the following Standards must be observed for the location of same: Cesspool-lO feet minimum distance from lot lines to center of cesspool Cesspools exterior must be lO0 feet minimum distance from nearest well Septic tank exterior must be 75 feet from nearest well Cesspool "Center" must be 12 feet minimum distance from nearest water line Cesspool "Center" must be i5 feet from house foundation Cesspool exterior must be 50 feet minimum distance from surface Waters, Streams, Lakes & Bays, etc. ~ ~ Cesspools must be 20 feet minimum distance' from t~rge t~ees Cesspool center to Cesspool center must b9 at least.~ mfeet Cesspool cover top to grade must be held -%o minimum of"l-~£o~d to maximum of 2 feet Bottom of Cesspool to ground water must be hel~.to,~ini~um of 1 foot NOTE: · = MONUM;'NT, SURVEY FOR MA RGOT OSBORNE MATTITUCK TOWN OF $OUTHOLD SUFFOLK COUNTY, N. Y. SCALE: 1% oCT. 23,1967 NOV. 2 I, 1967 DEC. 28,1967 MAY 3, 1968 GUARANTEED TO~ SECURITY TITLE ~5 GUARANTYC( SOUTHOLD SAVINGS SANK L AND SURVEYOR N, Y.S. L lC. NO. 28725 RIVERNEAD, N.Y. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No.., ,~.~...~-,~,~ ......... D~sopp roved o/c...~.~.......Z~...~'Z~....~.~..~¢!~~..;. ...... ................................................... ."7.1 iii ..... .......... (Building Inspector)./. ............................ APPLICATION FOR BUILDING PERMIT Date .......~...?.. ......... ./..~, ................................ 19..~..7.. .... 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 location 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 must 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. Upon 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 port 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 oil applicable laws, ordinances, building code and regulations. ..... '('~'i~r~'~'~'~'~'l~'~licant, or name, if o corporation) ...... ~. ~-... ¢. ¢.eZ~ ~..~¢~'.....E...~...c~.4.. ~.~ .....~....~¢.. .... (Address of a¢'plicant) -- State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..................... .~.c~.~.~ ....... ~,~.¢-~_~...¢7.~ ..................................................................................................................... Nome of owner of premises ..... .,~.4.g~..~. ....... ~,~.~...0...~..~'....~.. .............................................................................................. If applicant is o corporate,_signature of duly authorized officer. ............. ................. (Name and title of corporaCe officer) 1. Location of land on which proposed work will be done. Map No.: ....~¢~..~ ............... Lot No.: ........................ Street and Number ..~./..-~--.~.~.~.~.°.~?.?.~.~.........~...~.~.4.~....~..~.~.~.~.....~...~..~.~ ...... ..~,.,~../.~¢~'...-r.......~../L,~.',,~:.. .................... 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 0¢¢4r ~4¢"~..~....~.~::-<:~:i/a~)7 ¢.,ive- ,;.~;i(, ~.r.'~.~..~.~ (~.4..~..~.~.~ 3. Nature of work (check which applicable): New Building ~. .............. Addition .................. Alteration .................. Repair .................. .Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ........ ,/.~..~.~.~.. ........................................ Fee ........ .//.~. ............................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of cars ...... .O...~...~. ............................................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........ ~ ............. Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .....~...o. ........................... Rear ......~.?. ................... Depth ..~....~. ................. Height .....)..~...: ........ Number of Stories ....... .~...~...~.. ..................................................................................................... 9. Size of lot: Front ..... 4~ ................. Rear ....'~J~..../~ ............. Depth .../..~...,~'.. ................... 10. Date of Purchase ...~fl.../..~.....Z.~.f;....'?~.. ......................... Name of Former Owner ..~'~ ............. ~.'~. .......................... 11. Zone or use district in which premises are situated ..................................................................................................... 12. 'Does proposed construction violate any zoning law, ordinance or regulation? ........... ..~_.~. ........................................... 13. Name of Owner of premises Z'~::,~..'~......~..t~..~..~.....Address ............................................ Phone No. /..~...~..~..~/.~ Nome of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ./~.( .~...~.~.~..4...~../..~.~......).~...C. ....... Address ~.'.~.C...~..u.~...~.~: ~.f¢~'. ............... Phone No~Z..~..-....~...~....~. PLOT DIAGRAM Locate clearly and distinctly ail buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW Yf:~RK~.~//~ / S S COUNTY OF ~....~ ' ' ................ · ~..~..L..~..~.'~..~.~.'...~.:...~...~.~../(.~./'.~ .................................... being duly sworn, deposes and says that he is the applicant (Name of individual signing application) abow~ named. He is the ......... .~.~ ...................................................... ~ ............................................................... (Contractor, agent, corporate 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 in this application are true to the best of his knowledge and belief; and that the work will be performed in fee manner set fo~h in the application filed therewith. .S.,~.~.,~:..t..~r.~ d~;tho~....~ ....................... , 19~'.Z ~4 , ~ ........ ........... ........ .............................. ~ ~ ~Atl H ~0 o ~2.0706~00, Suffolk Ue~$t~ ~erm Expires ~a~ch