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Home My WebLink About5340-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at ?..~..~.....~.A..~..~..~..~.,, ~-.~.N.L--Street Map No. -- Block No..-7 ........ Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... .~..~....~..~. ~ 19 ?...~pursuant to which Building Permit No..~".'-~ ?.~..~ dated ............. .~...~..U.~..~., 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 ....~.....~..N.~- ..... .~..,~..~./..L..y'. ..... ~/?..~'...ff..~..~../.A/...~. .................... The certificate is issued to /::- D N ~ k"/) ~ B k- k~ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval A~.~.../. ~.~. ( ?..7..27.. .~. ~ V./.~...Z~... UNDERWR,TER No ....... .......................... ~ous~ N~M~ER .... ~..0..~....St,~ ...... ~.~.~..g ..... ~ .~.~?.~ ................. ............................... ~. ~..-¢.~ .~..o..~...~. ~-~ ............................ Building Inspector FOll~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N, Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 53~t0 Z Dote ........................... .~.~ .......... 9. ...... , 19..~...1... Permission is hereby granted to: ............ ~.~.,,...111111~. .......................................... ............... ~.....cJ,.m~ *,,,,..s,,m .......................... ................... .~.....~M,~ ........................................ to ...~ ..~mL aae...t~M~,,..~eL~o~ ................................................................................. at premises located at ......... j~.~...J~'...~,l~ ............................................................................... .................................................... .~u~cb~g~ ...... 11 ,,'L .,. ..................................................................... pursuantc to application dated ............................. ~ ....... JL~ ............ , 19...~.'J., and approved by the Building Inspector. S-9 SCHD SUFFOLK COUNTY DEPAHTHENT OF HEALTH TO WHOM IT MAY CONCERN: Date Bldg. Permit The sewase disposal facilities for a structure located (Give deed location) ! have been inspected by this department and found to be satisfactory. SUFFOLK COUNTY DEPARTMENT OF HEALTH EASTERN DISTRICT, RIVERHEAD,N.Y. APPLICATION FOR APPROVAL TO CONSTRUCT PR1VATE SEWAGE DISPOSAL SYSTEMq Approval to construct said systems is requested,pertinent data herewith: Date t-Xpplicant D o Z oneJ.-/.Ig 6-Sub div Address ~f/ H.D.Reference No .%~--~Y6 2-Detailed property ]~ocation ~/.N~,# ~,e ~%. ~A ~/A! ~ 8-Lot No. Hamlet ~,~* ~,~ ~ ' Town A'~/~ ' -- %Private well? 3-Public ~ter supply name -- Distance to nearest main S-Lot Size~ Width_~ft. Length_~ft. (also enter on center plot plan below:) 5-Dwelling: Single Family ~ Two F~m~ly? ;-~Cellar? ~ Slab? ~_~ Crawl Space? ~.J 10-Proposed syste~: Septic tank / /Precast / /Cesspools ~.~Shallow pools Il-Septic tank inside dimensions: Volume Gals. Length ft. Width ft. Liquid depth 12-Precast sections: ~_.~/Number~_/Squ~re Ft. Cesspools: Block sizeL incs.D ins.ff Total blocks below inlet: ~1 !¢j ~2_~_~3 PLOT PLAN ill Capacity ~'~Gals. N ate th Data ?ept 0 2 6 8 l0 12 "Construction of authorized installations will be in The Undersigned CERTIF/ES: accordance with the Suffolk County Health Departments' current Standards, Bulletins, and amendments thereto, covering Private Sewage.D~Disposal Systems". / / 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 can be installed on this Plot. Date r/~/~ Signed (lo/65 ~evis.) s-15 DIiopprovod o/c .............................................................................................. " APPLICATION IS HEREBY/V~,DE to the Building D~partmont for the issuance of a Building I~rmlt pumu~nt to the Building Zone Ordinance of the Town of Southold, Suffolk County, N~w York, and other pppllg~ble I.m~ Ordin~ncm m Regulations, for the construction of buildings, additions or alterations, or for removal or d~molltl~n, ee I~ln dllcrlbod. The applicant agrees to comply with all applicable law~, ordinances, bulb code, housing ,and mgulatlonl. ..4.. ............ ~,~,p ............... ~.......c ............. : ...... ;f,,:.,,~..... /Address of applicant') ///~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electT~an, plumber or builder. ...................... ~.¢.~.. ~..~. ~ .4 ....... ,,c..~. ~.~.~ .~ .~. ~ .............................................................................................................. Name of owner of premlsee ............ ~.~ ............................ ~ ................................................................. If applicant Is a corporate, signature of duly authorized officer. (Name and title 'of corporate officer) 1. ~ati~ of land on ~lch p~ ~ will ~ done. Map No ...................... · ~ d ~'"" ,~ ~,~,~qq e ~ ~ ~w~ '~ ~o U~ .... ~ .... ............. ~,~ ~ ~i~ ..... ~ ...... ~....~ ............. ,,..,,~:~,.~,;~;;,~~ ............ ;~j ~ ~ .................... ........................................................................... . 3. Nature of wo~k (check. which applicable)~,~w Buildin.~...~...... ......... Addition .................. Alteration .............. Repair .............. ,~. Removal ..................Demolition .................. Other Work (Describe) ...................................... 4. Estimated Cost ........x.~.~...~.~...v/ .................................. Fee .......................................................................................... ~ ~ Q~ve -~-~ ,Zy /~ d~'~- (to be paid on filing this application) 5. If dwelling, number 6f dwelling units~..~.~.[ .~...~..:6~...~..~Number of dwelling units on each floor ............................ If garage, number of cars ..... ~X~e.. C~r~, ~ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ........ ~ ............... 7. Dimensions of existing structures, if any: ~ ...~.E..~....~.... ........... 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~.~.~e~... Rear..~.: .... Depth ........................ J~ ! Height ..../...~..[ ......... Number of Stories . o ~.. e~' ". ~s.?.~..~. ~ ........... 9. Size of lot: Front ..... ..~.t~. .............. Rear .......... ..~....~...: .............. Depth ....... ..~/...9~'.~....:. .......... 10. Date of Purchase .....~..~...~.......~......(.~..~.~. ................. Name of Former Owner /,~,J'./~..~......~....~....'~...~..~..../.'~...~ ...... 11. Zone or use district in which premises are situated .....~..e..~..¢.~...C..~....-~..(~....~.. ............................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? ..... ..'~..~ ................................................. 13. Name of Owner of premises ..................... //. ............ Address ~'. .......... Phone ................ Name of Architect ........................ ; ............................. Address ..................................... .(..~.. Phone No ..................... Name of Contractor ..~.~.~.~..Z..~../~.........~...~...~...,~.~....~...Address ..~...~.......~../Z.~..~..~.../...~/. ..... Phone No...~..~..~.~.....~, PLOT DIAGRAM / Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate all ~et-back dimensions fram property lines. Give street and block number or description according to deed, and show street names and Indicate whether interior or comer lot. STATE OF NEW,~'OP~K, ~ i e e COUNTY OF .~.....~..~e. ....... ~.~..~.~....~...~..~... ........ ~...~.....~...../~.......~-~......~... ..................... being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the .............................~.e.~......~'~..~.. ........ ~.....~. .................................................................................... (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 tha~ the work will be performed in the manner set forth in the application filed therewith. Swom to before me this / ....... ........ ....... ................... . .._ ,, No. r~.~lese00 ~v~r KITC#£N ~ L/Y/N~ ?~ OOP i ~ {ouYr~ ?~DNT DIAGDA~d "P4NOIt ' r I I"-1 -0- ~ canc. bll~. W ca~rSe~ ~U~ Onc. ~/a~. FOUNDATION PLAN ~ ¢,o1~ .. ,~ " = I'--0" $?£At~ £ LE.. ~XI T/ON .~ O ~Yo r e"on /'>~" "¸1 ,I