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Home My WebLink About6175-z ~OE.~I NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTI'fOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6175 Z Permission is hereby granted to: ..... .g.3,[~ .e. ~...c..~, .t..~.c.~.~ .o~...q.~.~. p. .............. ....... · ~b~ .....~ ,...B~,e~le..l~at, b ........................ ............ li.e~sn ....... l~"i"i: .................................... to It.~,~3.~., ~,¢i~...~e... ~,am:L~...~,x~ ~.3,;.: 5m g ..................................................................................... et premises Iocoted et '""~513t;"~' ...... ~ ............................................... Eee .1.~.e.. ~oa~.~.....~ ~eh e.~me ....... 11. s~'~' ........................................ pursuant to application dated ............................. ~(3g.....1.5~ .......... , 19.~..., end approved by the Building Inspector. Fee $...~,,ffl~. ........ muilding Inspector SUFFOLK COUNTY DEPARTMENT OF HEALTH APFLZCATZON FOR APPROVAL TO CONSTRUCT A PRZVATE SEWAGE DZSFOSAL SYSTEM 1. Applicant ~/-~ ~¢~, ~ go~ Phone~l~$~. Subdiv. ~P,~ ~d/w~ Address ~ ' ~ ~. _& ~ ~/,, /~'~-~---6. Section ' 2. Proper~y l~a~ion~ 7. Lo~ No. ~ 8. Private well ~ Villase~Tovuship ff~P&~ 9. Public va~er 3. Public ~a~er Company name Distance ~o main ~. Lo~ size: ~idth /~l' feet Lensth ~ fe~C (Enter on cen~er plot below) 10. Seva8e Disposal System: A. 900 Ballon septic ~ank: Precas~ /Bquivalen~ Block B. Leachin8 pools: Numbe~ ~ Precas~ ~Block Special Street The undersisned CERTIFIES: be in accordance with the ards thereto." Date~~.~_ If private well fill in blanks below: Tank capacity~Gals. Pump G.P.M. Total well depth Depth to G.W. Amount of water in well Test Hole Data Feet · 0 2 : i"~ 8 ~10 ' ~ r '9 12 '16 18 "Construction of authorized installations will Suffolk County Department of Health's current stand- Owner or FOR HEALTH DEPARTMENT USE ONLY. Based o~ the information presented herewith, ~t Disposalis the op'iniOnsystemOfcanthebe~ealthinstalledDepartment,on this plot~that an adequate'and }fy Sewage Date SiSned S-15 Revised 4/~/7a ,'APPLICATION. FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEM~ ~' ~, INSTRUCTIONS: Applications must be submitted in triplicate 1-Means Owuer or Builder. Address to which mail should be directed. 2-¥2ans ~e~ailed description of property location, together with street name and distance to nearest~ntersection of main thoroughfare, also Hamlet/Village & Township. 3-Enter name of Public Water Supply District, together with the distance to their main. 4-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-Name of subdivision. 6-Section number. 7-Lot number. 8-Private well: Enter "No" if Public water supply is available. Enter "Yes" otherwise. 9-Public water: Enter "Yes" if Public water supply is available. Enter '~o" otherwise. PROPOSED SYSTEMS: Answer to Item number 10, consult the Suffolk County ltealth Department's Standards for Sewage And Waste Disposal Systems Design of Residential Subsurface Sewage Disposal Facilities. Part I-Residential Subsurface Disposal Systems covering cesspools. PLOT PLAN: The following information is required concerning the Applicant's 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. 2. Surface waters-Streams, Lakes, & Bays, etc., located within a distance of 1OO feet of Applicant's lot lines, must be sho~n on the plot plan also. 3. Wells and cesspools now on adjacent lots must be shown on the plot plan, together with the distance to the Applicant's proposed Sewage Disposal Systems and well. 4. Where no buildings exist on adjacent lots, state "Vacant" on the plot plan. 5. Streets adjoining applicant's lot to the right, left or rear, enter street name. WELL LOCA. TION: To locate the well & sewage disposal systems on Applicant's lot, the following Standards must be observed: Well-lOO feet minimum distance from the nearest cesspools. Well- 25 feet distance from rear and rear sides of property lines when possible. Well- 10 feet distance from front, and front sides of property lines when possible. Well- 50 feet minimum below grade for well point. Well- 40 feet minimum into ground water for well point. Well- 4 feet 6 inches minimum below grade to well head and lateral water pipe. CESSPOOL LOCATION: Upon determination of the Sewage & Waste Disposal "t~q~e of systems,, re- quired, the following Standards must be observed for the location of same: 1-Cesspool- 5 feet minimum distance from lot lines to exterior of cesspool. 2-Cesspools exterior must be 1OO feet minimum distance from nearest well. 3-Septic tank exterior must be 75 feet from nearest well. 4-Cesspool exterior must be 7 feet minimum distance from nearest water line. 5-Cesspool exterior must be 10 feet from house foundatie~. 6-Cesspool exterior must be 100 feet minimum distmnce from surface waters, streams, lakes, & Bays, etc. 7-Cesspools must be 20 feet minimum distance from large trees. 8-Cesspool exterior to cesspool exterior, must be at least 8 feet. 9-Cesspool cover top to grade must be held to minimum of 1 foot to maximum of 2 feet. lO-Bottom of cesspool to ground water ~,~st be held to minimum of 2 feet. APPLICATION FOR BUILDING PERMIT 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 prem ses or public streets o~) areas, and giving a detailed description of layout ofproperty 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 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 Deportment 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, os herein described. The applicant agrees to comply with all applicable laws, ordinances, .building code, housing code, and regulations. (S gnature of app cant, or name, if a cdrporati~n) ........................ ......... ., ..... ......... ~/~aaress aT app icant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .~.~.~.~..~..~.¥~, C~,~.~. ~' .~..~.~..?... If~rporate, si~nat~dre of duly authorized officer. ~, (Nar~ and title of corporate officer) · ~ 1. Location of land on wh ch proposed, workwlJ, beodone NtapNo ~...,~'.~.....~......~.~...~.. Lntl~, ~ '~ Street and Number ...... .~..~..~..//.'.'.~..~.;..~...~.. ............................ ........... /~..~.~'~.'~"~.~..~..~.i;iiiiiiiiiiiiii ........ ~_ MunicJpa i(~ ..... T 2. State existing use and occupancy of premises 'and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ............ ~.~...~..~...~.... ......................... . ...... ....... b. Intended use and occupancy ...................... ..~.... ........... ~ ......................... 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 filing this application) 5. If dwelling, number of dwelling units ........ i.....~.. ........... 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, Jf any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of e)n, tire new construction: Front ......... ~..~.. ................... Rear .....~..~. ................ Depth ....~....'.~.. ............. Height ....../.~...~'~' ..... Number of Stories ......... /. .......................................................................................................... 9. S~ze of lot: Fro t ...... ./..~ ............ea ....~. ............................ Depth ................................ 10. Date of Purchase ....~'"'=~' ......... /.~..~..~.. ................. Name of Former Owner-- '~ --~.-,...~./..~.~..'~../..~.~.../~.,~) ....... 1 I.' Zone or use d str ct ~n whic~h Prem ses are s tuated .~,~.~ .-. ........................ ------ --../..... .......................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ...~...~.. ................................................ 13. Name of Owner of premises ~--~'/dR""~'"'~'~'"~"'~'~--~'"~'~f~dress,-~ h -- ~_~ ~ .~..~.~.~.~.~..c:..~..(;~./,~ ....... Phone N o.~..~. ~ .~..~'s~.~..-- ................. · ,,4.~. ........................... Address ~y'.~..~..~...~...~../..Z~....,~...~/. ....... Phone No ..................... Name of Architect Name of Contractor ....... .~.../~.. .................................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locote 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 occording to deed, and show street names ond indicate whether interior or comer lot. ./~ ~' STATE OF NEW YORK, ! ¢ ¢ COUNTY~OF~,~ ........................... $~'~. . ..................... ~..-~.,~'~'~t~ .............................. being duly sworn, deposes and says that he is the applicant (Nom~of individual signing aoplication) above named. He is the ....................~.x'~--,~ ........ ~,e..~>.~....~c.....~...~....~......~..'~....~....~..... '.(,~......~..~.~.. ........................................ · (Contractor, agent, corl~brate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work end to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and tha~ the work will be performed in the manner set forth in the application filed therewith. Swam to before me this ................ ........ ....... Notary Public ... County / (Signature of applicant) JUDITH T. BOK~N Notary Public State of ", '5 SU3'~OI~ COt.~T¥ NEAT,TN DEPARTUENT DATE JAN 1. 5 1973 The sewage disposal and water supply facilities fer this location have been inspected by this de~nt/ndLu% Chief of General Engineering Services NOTE,' · == MONUMENT S U~ V/S/ON MAP ~'/L ED /N THE OF THE CAEI~K O~$U~'I~O0< ¢O~VtTY ON dUNE R, 19?~ AS ~£ENO. REVISIONS YOUNG & YOUNG 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALOEN W. YOUNG HOWARD W. YOUNG SURVEY FOR: CLAUSEN CONSTRUCTION CORP. LOT NO. 3," BAY HOMES" TOWN OF SOUTHOLD SUFFOLK CO., N.Y. BY~/~/~.~~ SCALE: I" = 50' IDA.rE: dAN. 5, 1973 NO. 7;~-6 ! I -t i