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Home My WebLink About4801-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy Date .............. ]Iov ....2~. .... , 19 -~0. THIS CERTIFIES that the building located at B~. Bt),. VI~w. ~ ....... Street Map No.. ,w ........ Block No...~m ..... Lot No...m .... 8~4~l~1~... Jl..~o ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ ~UO.. '9 ..... , 19. ~) pursuant to which Building Permit No..!~(1~..l dated ........ J~i~'' '¶2 ..... , 19. ~, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . I~$V~ '~ -fa~t~ 'dwOll:S~ ....................................... The certificate is issued to .St~lOy. (~,~l'Uh' Jr · · · ~ ........................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval FORM NO, 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THI: PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? ~801 Z Permission is hereby granted to: ................... ~.t.....~ .............................................. .............. JB,tJ, l~..P, laea ......... il,,~to ................. to ............ ~...~...~.~......t...~i,~..~,~,l.~a ....................................................................... at premises located at ............. ..~..~,.......~..~.~..~..~.e..¥....~..~1~.,.~..?...?. ............................................................ ...................................................... .~.e~.t~.;l,~ ......... ~i.~.~ ................................................................... pursuan¢ to application dated ............................ .~.1~1~. ......... ~ .......... , 19..~.ID;, and approved by the Building Inspector. Building Inspector SUFFOLK COUNTY DEPARTMENT OF HEALTH EASTERN DISTRICT, RIVERHEAD,N.Y. APPLICATION FOR APm~O~AL TO, ~CO~T,_RUCT PRIVATE SEWAGE DISmSAL SYSTEMS, Approval tn constma,c~.'.'SAid~ systems'ls~requeated,pertinent data herewith: Date ~ 1-Applicant ~.~ .. ,, . . ,,., ~hone 6-Sub div Address ! ~ /,% , ..... ~, ~, , 7-Section ~_ 2-Detailed property location~ --9~ 8-Lot No. ' Hamlet /Wo 9-Private well? 3-Public water supply name Distan~-~arest main 4-Lot Size: Width ft. Length ft. (~l~nter on center plot plan below:) 5-Dwelling: Single Fam, ily ~ Two Family? ~ /Cellar? ~,/.Slab? J J Crawl Space? J ~ lO-Proposed system: S~tc taD~S-~ tPrecast F tCesspools ~_/Shallow pools ~_/Ot~ ~ Il-Septic tank inside dimensions: Volume Gals. Length ft. Width ft. Liquid. depth__ft. 12-Precast sections: /'l~umber/ /sqUare Ft. Cesspools: Block sizeL incs.D ins. H--ins. Total blocks below inlet: ~1~_~2 ~3 PLOT PLAN Capacity~ls. The Undersigned CERTIFIES: "Construction of authorized installations will be in accordance with theSuffolk County Health Depa=tments' ~urren~. Standards, Bulletins, and amendments ~her~ covering Private ~e~9 ~I S~ems". Owner or Builder FOR HEALTH DEPART~NT USE ONLY. Based on the information presented herewith, it is the opinion of the Health Department, that an adequate and satisfactory Sewage Disposal System can be installed on this Plot. Date ~/~/2d Signed (10/65 Revis.) s-15 APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS INSTRUCTIONS: Applications .mst be submitted in triplicate 1-Means Owner or Builder. Address to mbich 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 Publid 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. ~-Name of sub-division ?-Section Number 8-Lot Number 9-Private well: Enter "No" if Public water supply is available. Enter '"fee" otherwise. PROPOSED SYSTEMS: Answers to Items number 10, 11, & i2 please consult the Suffolk County Health Department's Standards, ~,11etins 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 line~ of the heavy lined square in the center of Plot Plan shewn on face of this application. Surface waters-Streams, Lakes, & Bays, etc., located within a distance of 50 feet of Applicant's Let lines, must be shown on the plot plan also. Wells and Cesspools now on adjacent lots "mst be shown on the Plot Plan together with the distance to the Applicants proposed Sewage Disposal Systems an~ 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 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 100 feet minimum distance from nearest well Septic tank exterior must be 75 feet from nearest well Cesspool "Center" "mst be 12 feet minimum distance from nearest water line Cesspool "Center" "mst be 15 feet from house foundation Cesspool exterior "mst be ~0 feet minimam distance from surface Waters, Stre,m,~ Lakes & Bays, etc. Cesspools must be 20 feet mintw, m distance from large,tx~e~ Cesspool center to Cesspool center .mst be at least l~ 'f~ Cesspool cover top to grade .mst be held to minimum of~ ~ ~o~o~f 2 feet Bottom of Cesspool to ground water .mst be held to min~u~ 03A 3 3 SCHD SUFFOLK COUNTY DEPARTHEHT OF HEALTH Date Bldg. TO HHOH IT HAY CONCERN: The e. ewase disposal facilities for a structure located d~e~ocatiou) have been inspected by this department and found to be satisfactory, Distrlot ~l~elx- District Engineer ~mined Approved 'toWN OF sou'mOLD BUILDING DEPARTMENT TOWN CLERIC'S OFFI¢= ........................................ , 19 ........ Permit No ........ ....................... ..................... APPLI~.~6,TION FOR BUILDING fEl~ri' INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink und 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 o 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 o 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 app icoble Lows, Ordinances or Regulations, for the construct on of bu Id ngs, additions or a terations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, (Signature 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. Nome of owner of premises ...... .~.'~..~x)~ .......... C. .................... I If applicant is a corporate, signature of duly authorized officer. (Name and title 'of corporate officer) 1. Location of land on which proposed work will be dane. Map No.: ................. ~ ................ Lot No.: ........................ Street and Number .~-./~ ..~....'~.../../~... ~..~.~...~../.~w~.~/~ //~.~..~'/,~zlx,~ ,~--~_,, ~Y//'/~--~u 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 occupanc,' ~,-~4~'V--/ '~V,V,~.L.L. IIJ4~ ' 3. .No1~d~ of wo~k ((~beck whc~ app cabe): New Building ,,.; ....... Addton Ateroton Repair ................... ~R~movol .................. Demolition .................. Other Work (Descr be) ...................... 5. If dwelllng, numbe~ 0t~ dwelling units ... Number of dwelling units on each floor ............................ 6. If busine=, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Oimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height .......................... u~Umber of Stories ......... 8. Dimensions Df e?ire new construction: Front ...... ,,,,~,.~! ............. ~,,..; Rear ............................ Depth ........................ 10. [~3te of Purchase ........................................................ Nome of Former Owner ........................................................ 11. Zone or use d[strlct in which premises are situated ..................................................................................................... 12. Does proposed construct on v o ~te any zon ng aw, ord nonce ~r ragu at on 13. Name of Owner of prem ses Address ~ne Nn Name of Architect ..................................................... .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 number or description according to deed, and show street names and indicate whether interior or corner Jot. STATE OF NEW YO~_l~ _ . I S.S COUNTY OF ....~.~...~.....~'~.....~...~.. J' · .................... ~-~'~)~...~'.l~--.~,,~---~...~t~-~. .................... being duly sworn deposes an~ says that he is the applicant (Ida of ' d'vidual signing app corian) above named. He is the ............. ~,,~J,~~,~ ................................... (Contractor, ~_~f_x:--r, 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 wo~k will be performed in the manner__s.?t~ .fqrth in th.e ~oppli~c. at!?n~filed therewith. Swom..,to ,,L~ f6[e. me this ~~ L"'"'''"7 f '~'" mum~l~::~ -~.. t~t:# PP FORM NO. 4 TOWN OF SOUTHOLD' BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. ~ll~POt~i~¥ Certificate Of Occupancy No. ~'-~'026 ...... Date ..... ...... 0~.~ .....2.] ...., 19.70. THIS CERTIFIES that the building located at 1~/8. ii,ay. ]/iew. Road ....... Street Map No. :X~ ...... Block No .... ~;x . Lot No..XlC~; .... So'~li;hoJ;¢l ... ~,¥, ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... June ..... 9 , 19. ~0 pursuant to which Building Permit No..bS0iZ. dated ............ June...12r, 19 ?0 , 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 . Private. one. family, dwelling ...................................... The certificate is issued to . Si;al~ey... Cieraeh .Jl' .... .... 0~ner ................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval aou~e # 176~