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Home My WebLink About5069-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Occupnncy No. ~1+27.7Z ..... Date .......... J.xUl¥ ....~ ........ , 19..71 THIS CERTIFIES that the building located at . .~':es.twoocl .La ............. Street Map No. ~.astern .~11 Block No .... xx .... Lot No. 81 ....... G~.een.~o~t .... ~.Y, .... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... NO~,. 2.1+.. , 1970.. pursuant to which Building Permit No.. ~0~9~. dated ........... No'~.. 2~-.., 19.70, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .. 'Pr~v~.te. one. family, dw®t~.~n.g ..................................... The certificate is issued to .. Em~mu~l .l~$g~tak.~.s ..... 0~m®x, ....................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . June...2~. ~97~ · ' by .H....Vit'l~ · · Under~.ters cert ~N880989 ~/c~.., ~--~ House ~ ~2~0 ........ (-~w~ ........ ~"~' ':"~1 ..... Building Inspector ~ FOP~I NO. 2 TOWN OF $OUTNOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISE COMPLETION OF THE WORK AUTHORIZED) UNTIL FULL N? 5069 Z Dote ............: ...... ~ ......... .~. ...............19.:..~.~ Permission is hereby granted to: .............. .~.3~t....~,,..:~oa..~tt ......... ; ................. ................... l~ve'e~ ................... :'~ ................. to .... ~A.~.~, · .eev...~ae..-t-e~:-l.~.. 4-we~.l-~ t~t~ .......... '. .......... ! ......................................................... ct premises located at ........ ~l~t.,~,....~a, ltf~a~..~ ....... ~t4a~ti:.~[.Z ................................................ ................................................. G~e~o~.t~ ......... ~.~ ............ i ......................................................... pursuant to application dated ................................ .~.....~..?..., lg..e/~., and approved by the Building Inspector. Fee $.....~(~ ....... ouilding ~nspecror / BUILDING DEPARTMENT TOWN CLERK~ OFFICE ~, N.Y. ~?~*/=, ................... A~r~ ~ .................. x .................... , ~9.t.:... p,rm, ~o..~o...~Z....L.,. Disapproved a/c .............................................................................................. .... (~;o;) ............... APPLI~6,TION FOR BUILDING PERMIT /../ Date ............... /./.~..~.~./.....~. ..................... ,19 ............ a This application must be completely filled in by typewnter or in Ink und subm tted In duplicate to the Building- , ns~ctor. . ~ b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premlse~ or pub c streets or ~ areas, and giving a detailed description of layout of property must be drawn on the diagram whlch II part of thle application. ~7 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 luue a Building Permit to the applicant. Such permit shall be kept on the premises available for Ir~oectlon throughout the progreu 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 Bud ng Perm t pureuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other app cob · Lava, Ordinances or Regulations, for the construction of buildings, addltlonl or alterations, or for removal or demo t an, al here n descr bed. The applicant agrees to comply with all applicable lows, ordinances, building code, housing code, and regulations. '. (Stgnatur~f/cf applicant, or name, If a corporation) ' ' (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......... ........................................................................................................................................................ Name of owner of premises .~.Z~Z'4t./.,/~I'~../~...<~'.../. ........ ../~-../.:~..~../4-~...~"Z°z./.,L~.:.-~. ................................................................ If applicant is a corporate, signature of duly authorized officer. '~ (Name and title 'of corporate officer) ~. Location of ~ond on Which proposed work w", be done. Map No.: ...~.. ........................ (- ~' 4, ......... 'at No.'...~t. ............... ~ Street and Numbor~/.~..../~.A'.~..~..e.~......,4..~.g.~ .................... ~.~ .~.......~.~ ...................... Munlclpa Ity ..... 2. State existing use and occupancy of premises and Intended use and occupancy of propoaed construction: a. Existing use and occupancy ......................................... b. nt.nded u, and occu,onc ,' ........ ........... ............................................... 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 fi~ing this application) 5. If dwelling, number of dwelling units ........... ..~... ............ 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: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear Depth ................................ Height ............................ Number of Stories ................................ 8. Dimension; ~,,entire new construction: Front ..... .~...~..~..~....~ ............ Rear ....~.~.,~..~...~..~. ........ Depth ...~...~.~...~..../ ....... Height ...[..¥ ............. Number of Stories ............/. ........................................................................................... 9. Size of lot: Front .......~...O....8. .......... Rear ~ ,./~(.~.. .... Depth ..../.~....~.' ~./. ~. 10. Date of Purchase ....... ~.~.~..~.. .................................. Nome of Former'Owner .~.~./.-.~..~..~.......~.~..~.~..4[:..,s?.....~..~.. ~., 11. Zone or use district in which premises are situated ............................................... 12. Does proposed construction violate any zon ng aw, ord nonce or regu at on;~ .~-/.~.. 13. Name of Owner of prem,ses .~..'...~.~2..~...~-..~..~../l~x/~....Address ~¢~.~/..~..:.....Z~..Z..4~... Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .4~..~/&fZ~./~..~......~,./..~....~..~.. ......... Address ,//~l..~.......~......A~l..f~.(..~...v('~.....~'..'~... phone No.~...L..?..?../...~..6.~ 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 number or description according to deed, and sh°w street names and indicate whether interior or comer lot. ~ STATE OF NEW YORK, lee yz~..'.~ ~ .. ' being duly sworn, deposes and sa s that ~he is the a cant ~'Y', (Name of individu~ ~op catipm~ >-, ' ~ ~ · .. aboveJrna~ed He is the ' ............................................................. i~¥~c'~, '~CT~';X'~;"~f~;;:'~';:i ............... of said owner or owners, and is duly authorized to perform or have perfo~ed the said work and to ~ke ~d file this application; that oll statements contained in this application are tree to ~e best of his knowl~ge and belief; and that the work will ~ performed in the manner ~t fo~h in the application filed therewith. Swam to before ~ ~is .... :~.~ ........ ~ of ..: .~...:- .......... , ~ ff o ~ ~ ~ ~ . . . ,u.,, ......... ...... .................. ~o y ~ 'c, .. ........ ~.~...,~......:~ Coun~ ~ (Signa~re of applicant)~ ~_~' ~ ~' // 8-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg. P~rmit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located (Give deed location) have been inspected by this department and found to be sati~fa~t~y~-) Ohie£ of Gono~l Engineering So~icos __ District Engineer i H.D. Reference No EASTERN DISTRICT, RIVERHEA~,N.Y. APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Approval t~ construct said systems is requested,pertinent ~ata herewith: Date 2-Detailed~roperty location ~/g ~ ~ o ~ ~ 8-Lot No. Hamlet ~D~ ~ ~ To~ J~ ~j~ ~/~ ~ 9-Private well? 3-~blic water supply name ..... Dzstance to nearest main 4-Lot Size: Width/~ ft. Length~ft. (also enter ~n center ~lot plan below:) 5-~elling: Single Family ~ T~ Family? ~Cellar? ~lab? / ~Crawl S~ce? / / lO-Pro~sed system: Septic tank ~ /Precast / /Cesspools /~/Sh~llow pools / /Other / il-Septic tank inside dimensions: Vol~e Gals. Length ft. Width ft. Liquid depth ft. 12-Precast sections: / /Number~Sq~,re F~. Cesspools~lock size~ incs.D ~ ins. H ~ ~ns. Total blocks below inlet: ~1 /~2 ~] PLOT PLAN Capacity Gals. Indi ~ate 'th G. P.M. Teat Data ~eet 0 2 6 8 10 12 (10/65 Revis.) s-15 The Undersigned CERTIFIES: "Construction of authorized insta%lation: will be in accordance with the Suffolk County Health Departments' current Standards, Bulletins, and amendments thereto, covering Private Sewage Disposal S~stems". Owner or iBuilder FOR HEALTH DEPARTMENT USE ONLY. Based on the information ~resented 7herewith, it is the opinion of the Health Department, that an adequate and satisfactory'Sewage Disposal System can be installed on this Plot. APPLICATION FOR APPROVAL TO CONSTRUCT PR/VATE SEWAGE DZSPOSAL 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 7-Section Number 8-LOt Number 9-?rtvate well: Enter "No" if Public water supply is available. Enter '~Zes" 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 PLOT PIAN: 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 ~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 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-10 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 minimum distance from nearest water line Cesspool "Center" must 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 bt at least 16 feet Cesspool cover top to grade must be held to minimum of 1 food to maximum of 2 feet Bottom of Cesspool to ground water must be held to minimum of I foot J tl~,° i k. o+ NI~ 8~. 5UrLVEYF{) IEMAMUEL IF leET,~.KI5 FRONT ELE~/~ T/O/V ,,,e C.4 £ E . ,/~ ".1; 0~ /_£A-7- SIZ3£ PLUME lNG , I~IGI¢ T J/DE EL E]/A T/Off '--...d r 1 REAR ELEI/,4TIO/V _ROMART BUILDEF?S ~ECTIO/V