The URL can be used to link to this page

Home My WebLink About5013-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPAHTMENT Town Clerk's Office $outhold, N. Y. Certificnte Of Occupnncy No. ;~,2~.~ ...... Date ................F~7 .... ~l.8..., 19..7.~. THIS CERTIFIES that the building located at . I~/S. ~.illqe. ~ ....... Street Map No. V~a$e. ~ck No ........... Lot No.. ~... ~$~k...[~ ......... confoms substanti~ly to the Application for Buil~g Permit heretofore filed ~ ~is office dated ...........0e~ ....~.~, 19.7~. p~suant to which B~lding Pemit No..~0~. dat~ ........... 0e~ ....20., 197~.., was issued, ~d confoms to ~1 of the requ~ ments of the applicable pro~sio~ of ~e law. The occup~cy for which ~ ce~fficate is issued is .. P.~a.~. ~. E~.$~Y. ~$~$P[ ..................................... The ce~fficate is ~sued to .. W~lter. &.E&$t~. J~ks~ ....... ~era ............. (owner, lessee or ten~t) of the afores~d b~l~ng. Suffo~ Co~ty Depar~ent of He~th Approv~ ' ~' · ~ ~' '~ 97'~' · 'bY' R.. ~.~lla ..... R~se~ 117~1 U~iter. Cert ~ ~ 87~ .... ........... FOIJ, M NO. ~; TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT N.o (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 5013 Z Do*e ....... , .; ........ ', ~,~' f':~' 19...~ Permission is hereby granted to: . · , · to . J~i~iL~ llJetf ~ -~jlJlJl,~.~ ~N'e}.~,fl~jj ............ ~ ........................................................ ,or premises Iocoted at ........ , pursuaat to application dated ...................... : ....... ~T ...... ~J~......~?.., 13uilding Inspector. r~' a. This application muSt be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. r b. Plot-plan showing location of lot and of buildings on premiess, relationshio to adioinina oremlses or oublic'streets or areas, and g v ng a detailed description of layout of property must be drawn on the d agram which Is port of this app icatlon. 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 ppplicant. Such permit shall be kept on the premises available for JnepectJon 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 ~gulati.ons, for the construction of buildings, additions or alterations, or for removal or demolition, as here n descr bed e applicant agrees to comply with all applicable laws, ordinarices, building code, housing c~ode, and regulations. ....... ........ . State whether applicant is owner, lessee, agent, an ' ineer, general contractor, electrician, plumber or builder. (Nome and title of corporate officer) Locat on of and on wh ch p work 11 be done. JV~ap No.: .....~......~....~...(~. .............. Lot No ...... ~ .............. Street an mbe I,) ,~ .... ~ ~1,,9~, . 2. State existing use and occupancy of premises and intended use and occupancy of prapoe~:J construction: a. Existing use and occupancy .... : ........ ~ ... . b. Intended use and occupancy ..................... ,~ ........................................................ i ................... 3. Nature of work (check which applicable): New Building ...... ...~%... ...... Addition .................. Alterotion .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ...... ~....~..~..~k..8...0...~.'~.. ............................... 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 cors .................................................................... ; ........................................................................ 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 olterations or additions: Front. ................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ......':~....'~... ....................... Reor ........ ~...~... ......... Depth ....~:'...~....~. ........ Height ....... [~... ..... Number of Stories ..............~ .......................................................................................... Size of lot: Front ../.~..~. ................................................... Depth .............................. Date of Purchase .........../.,~..~..0....., .............................. Name of Former Owner ........................................................ Zone or use district in which premises are situated .............................................. .~ .................................................. Does proposed construction violgte any zoning la~,.o[~Lnang~e or regulation?; ......... .~..;. Name of Owner of premises..~..~..~...~.~.~,,~.L.~,.:~,,'~/.~ ............................................ No.'~.~.~..-..~?'..!.l.. Name of Architect ................. ~ .......... ;.. ..................... Address Phon~ No ..................... Name of Contractor ...~..~..~.~.~ N o.~. ~.~F..J .~...2~..{~. ....... Address ..: Phone PLOT DIAGRAM Locate clearly and distinctly all buildings, whether exieting 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. 10. !1. 12. 13. STATE OF ~IEW Y~---~,.j~ ~_S~:s . .............................. ~~..being duly sworn, deposes and says thot he is t~ applicant (Nam~ i~i~d~al sig~ng ~licoti.~ .' ~ above named. ~e is the ................................. J.~.~ ........................................................................................... (C~tmmor, ~t, co~orote officer, ~c.) of said owner or ownem, and is duly authorized to pe~rm or b~e perfo~d the ~id work and to ~e ~d file this application; that all statements Contoined in this' applicati~ am tree to the best of his ~l~ge a~ belief; and that the work will ~ performed in the manor ~t fo~h in the ~plic~i~ f~ t~ith. Swom~ ~fore me this ~ o, ............ , Nota~ Public, ~Z~~:"'~;a~re of applicant, y / ~o. ~. ~k Co~ ~ Term Expires M~rch $-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Bldg. P~ermit No. TO WHOM IT MAY CONCERN: ~a~e ~ee~ i~spected The sewage disposal facilities for a structure located / (Give deed lo~/ation) ~ /- by this department and f~und to be satisfactory. Chief of ~ene~al ~ngineering Servlco~ . ,.' SUFFOLK COUNTY DEPARTMENT OF HEALTH HoD.Reference No EASTERN DISTRICT, RIVERHEAD,N.Y. APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL sYSTEMS Approval to const~ct s?i,d systems is re~uested,pertinent data herewith: Dat Addres- - _ ~. ~ , _ ~/1 ~ 7-Section - 2.Detail~8-Lot No. Hamlet ' · Tow~~9-Private well? ,, Distance to nearest main 3-Pablic ~%~.ter suppl~,name 4-Lot Siz®. Width ~&~" ft. Length ~$-F'ft. (also enter on center plot plan below:) 5-Dwelling: Single Family ~fTwo Family? ~_~Cellar? ~Slab? ~_~Crawl Space? lO-Proposed system: Septic ~-nk ~ ;Precast ~ /Cesspools ~Shallow pools ~ /Other ~_/ il-Sept'lc tank inside dimensions,: Volume Gals.Length ft. Width' ft. Liquid, depth ft. 12-Precast sections: / ;.Number~_/Squa~"~. Cesspools: Block sizeE-~ incs.D~_ins. H~_ins. Total blocks below inlet. PLOT PLAN Data ~eet C' 0 6' (), 8 ~r ~2 Signed~ can be installed on this Plot. (10/65 Revis.) s-15 The Undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Health Depart~ents' Cur_rent Standards, Bulletins, and amendments thereto, covering PrivateSewa~stems". Date I $/~/) O Signed ' ~ '~ · ~r Builder FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the opinion of the Health Department, that an adequate and Satisfactory Sewage Disposal System APPLICATION FOR APPROVAL TO CONSTRNCT 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 F-Section Numbe~ 8-1Lot Number 9-Private well: Enter "No" if Public water supply is available. Enter "Yes" otherwise. P__~POSED 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 P__~T 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-lO0 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. 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-lO feet minimum distance from lot lines to center of cesspool Cesspools exterior must be 100 feet minimum distance from nearest well Septic tank exterior must be 75 feet from nearest well Cesspool "Center" must be 12 feet minimu~ distance from nearest water line Cesspool "Center" must be 15/~9~t fEom~ouse foundation Cesspool exterior must be 50 '~e~i~%m~m. distance from surface Waters, Streams, Lakes & Bays, etc. Cesspools must be 20 feet mi~s~n$e~from large trees Cesspool center to Cesspool cente~ must ~ ~east 16 feet Cesspool cover top to grade must~.be,~e~.,~o mmn~mum of I food to maximum of 2 feet Bottom of Cesspool to ground water mus~ b~ held to mmnmmum of 1 foot \V¢,6 LTE P_. l- h- <I 0 LOT Nf~ 8 LOT rz 'z -z3 \ I I