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HomeMy WebLinkAbout3719-zI~OP~M N~O. 4 TOWN OF SOUTNOLD BUILDING DEPARTMENT 'I'OWN CLERK'S OFFICE SOUTHOLD. N. Y. THIS CERTIFIES that the building located at .~.~....~I.O~.$Q~ .~l~.ad .......... Street Map No .... ~ ...... Block No ..... ~ ..... Lot No.. ~ .... l~JXttilll~ll~.. ~[,~ ....... conforms substantially to the Applicati. on for Building Permit heretofore filed in this office dated ....... NO'~' 2)* 19 6~ pursuant to which Building Permit No. dated ...... .~..O.V.....2.~. .........19..~.~, was issued, and conforms to all of the require- ments .of the .applicable provisi.ons of the law. The .occupancy f. or which this certificate is Private one family. ..d.~.e..1.1.i.ng issued is .................................................................. The certificate is issued to .. I~I~S., .R~I~. ~t,[/al],~laa, l~l~ ......... ..0~....~.~ .................... (owner, lessee or tenant) of the aforesaid building. ,Suffolk County Department of Health Approval .~..a~....~.~...].~.6..~...~..0.*..~it~ ...... l~Olt~ NO. :B TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFI~"E SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUSI' BE KEPT ON THE PREMISES UNTIL FULL. COMPLETION OF THE WORK AUTHORIZED) N? 3719 Z Permission is hereby gmntecl to: at premises located at ..~.~.....~TtQz'~t~)~..~ ................................................ ~ ................. , ........... ........................................... l~.t.tJ.~t% ...... Ji.Z,, ............................................................................ pur~ucn'~ to ~ppli¢~tion dc~'~d ....................... .i~ ........ ~.~ .............. , I~...~, ~nd ,',ppro~d blt th~ Building Inspector. Fee $ ..................... Building Inspectc~7 ~ SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D.Reference No ~0-~>~/ D~te EASTERN DISTRICT, RIVERHEAD,N.Y. APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Approval tn construct said systems is requested,pert%nent data herewith: 2-Detailed property locati~n~No tO~ ~. ~--~d~ }~ ~g 8-Lot No.' 4-Lot Size: Width r~ ft. Length ~ ft. (also enter on center plot plan below:) 5-~elling: Single Family ~ Two Family? ~ ] Cellar? ~ ~ SlaB? ~ ~ Crawl S~ce? ~ ~ 10-Proposed system: Septic ~ank ~Precast Y yCesspools ~Shallow pools ~ /Other ~ il-Septic ta~ inside dimensions: Vol~e Gals. Length ft. Width ft. Liquid depth ft. 12-Precast sections: ~Number/ /Square Ft. Cesspools: Block sizeL incs.D ins. H ins. Total blocks below inlet: $1~ ~2 .... $5... PLOT P~N Ta~ Ca~ cit~Gals. Data ~eet 0 2 4 6 8 10 12 14 16 18 ~ m Street , No ;h / The Undersigned CERTIF~S: "Construction of authorized installations will be in accordance with the Suffolk County Health De~rtments' current Standards, Bulletins, and amendments thereto, covering Private Sewage Disposal Systems". O~er or FOR ~ALTH DEPART~NT USE ON~. Based on the info~ation presented herewith, it is the opinion of the Health De~rtment, that an adequate and satisfacto~ Se~Ee Dis~sal System can be installed on this Plot. Date ~~' Signed (10/65 ~evis. ) S-15e .A~..PLICATION 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. Z-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. ~-Dwellings: Check-mark "V" items applicable to the proposed new dwelling. ~-Name of sub-division 7~-Section Number 8~-LOt Number 9~-Private well: Enter "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 covering 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-10 feet ~inimum 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-$ feet 6 ins. minimum below grade to well head and lateral water pipe .CESSPOOLS LOCATION: Upon determination of the Sewage & Waste disposal "type of systems" required, the following Standards must be observed for the location of same: Cesspool-10 feet minimum distance from lot lines to center of cesspool Cesspools exterior must be i00 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" mu~st be 15 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 large trees Cesspool center to Cesspool center must be at least i6 feet Cesspool cover top to grade must be held to minimum of I food to maximum of 2 feet Bottom of Cesspool to ground water must be held to minimum of I foot T~OWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERKt$ OFFICE SOUTHOLD, N. Y. Examined ...~ ....................... ¢l~_t,J~ , 19.f..~.. Approved ........................................ , 19 ........ Permit No. ~ ''~ [ [ ~-~ Disapproved a/c ....... ~ 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 ~reas, 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 issuence of Building Permit. d. Upon approval of this app[icatlon, 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 part 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 applicab e aws, ordnances, bu Id ng code, housing code, and regu arians. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engi.neer, general contractor, electrician, plumber or builder. ............................................. O~me~ ........................................................................................................................................ Name of owner of premises .~..-~.~...~.'1-3,~...~,.'[;.l~a,..~.~ ................................................................................................... If applicant is o corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ............. ~ ...................... Lot No.: ....;~g~ ............... Street and Number ,..~./,~...~..°.?.,~,°,~..~..°**a:.~,~...~.~.$.~:~.~.,...~**.Z?. ..................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... V'...~..o...a:~.l;.....]-...at.~..~. .................................................................................................. b. Intended use and occupancy ......... ¢~¢....~..~$~l,~...¢,~e~,],;l.~j~......(.e.l%~a,~.g¢cl...~o]~.;2~.]/o~e.) ................... 3. Nature of work (check which applicable): New Building ..~... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ...8~..5'O0...P.r'~I ................................... Fee .....$.~.O.~.Q ....................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ........ .O1:1~ ............ Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Frqnt ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with a,lterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ..... ~.O ........................... Rear ........ ~...0. ................ Depth 1'2/21+ Height .................... Number of Stories .......... Olle ..................................................................................................... 9. Size of lot: Front ...... ,],0.Q .............. Rear .......... ~..0..0. ................... Depth ......... ~.0..0. ................ 10. Date of Purchase ..... 1,96.~. ......................................... Name of Former Owner ..... ~.~..b..O...Z'...~..~..O. ........................... 11. Zone or use district in which premises are situated .....ttA.tt..d.~.S.~ ............................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? ............ D.~. ........................................... 13. Name of Owner of premises .lq. lZtl0....k4h~tlllal'.Sh....Address ........ ,N.~?,...°q~..~..~..e...~. .............. Phone No ..................... Nome of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ....~.~1~..~. ...................................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly oil 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 NE~ Y~K~ 1 c e COUNTY OF .~J~'.~ .............. Mrs uth Whitmarsh ........................................................................ =....~ ...... ~ ............ being duly sworn, deposes and says that he is the appl ~t (Name of individual signing application) above named. He is the .................... Q~ ......................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is du~y authorized to perform or have performed the said work and to make and file tNis applicoUon; that that the work will be performed in the manner set forth ~n the appJicatJon' filed therewith.