The URL can be used to link to this page

Home My WebLink About6231-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy .............. ~'~; L;~;;~;' ~ ..... THIS CERTIFIES that the building located at ~ ...... ~ ....... ~.....~... Stree~ conforms substantially to the Application for Building Permit heretofore filed in this office / dated ~ , 19~..~'"pursuant to which Building Permit No. ..... ....... . . ....... dated ....................... , 19 ...., was issueu, and conforms to all of the require- ments of the,~licable provisions of the 1~!~ The occupan~his certificate is issued is... ~..~.... ~..~.. k~.~.~ ............... The certificate is issued to ~ .... ~V~s~. ~~ ............ ..... of the aforesaid building. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE No .......... ..m ..................... , ................. HOUSE NUMBER...'~.tT/.0 .... Street ....~---~.~. ~ .................. Building Inspector FORM NO. 2 ToWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N;. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE pREMISE~ UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6231 Z Date ....................... Permission is hereby granted to: ............ ~..o.~.e.~ .c...o.~e;L~ .................................. ................... ~e~%he-l~ ....................... : ................. to ,, ~a~...~W.. ~1~ .. ~ly--c%~! 1'~ ......................... : ......................................................... at premises located at .........JitD~'"~O ....... Jl~jti~l' ~PII~ '"' .......................... ~lea~t~ew...A~re .............. 8otttj~e~l~t'''''';3! 'Y'' ................................................ pursuant to application dated ; ....................JJ~ ............ 6'""!'*"'" 19..s~., and approved toy the Building Inspector. Fee $~,~.~.60. ........... APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM ' Phone 5. Subdiv. '~ 1. Applicant , ~ . / .- Address ~ ~' 6. Section 2. Property location~J ~r-~?~ '~ - '~' ;" ~ Lot No. .... ~ ~ ' 8. Private well Village Township 9. Public water 3. Public Water Company name Distance to main 4. Lot size: Wid~/~,~ feet Length i feet (Enter on center plot below) 10. Sewage Dispos~ ~Ystem: , A. 90~ gallon septic tank: ~recast~Equivalent__Block B. '~eaching pools: Number ~_~_Precas~(gJBlock Special If private well fill in blanks below: Tank capacity~ ~Gals. Pump G.P.M. ~' Total well depth__ Amount of water in well Test Hole Data Feet 0 2 4 6 8 10 12 14 16 18 The undersigned ERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health's current stand- ards thereto." Date Signed ,~-" / ~ Owner or Builder FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the opinion of the Mealth Department, that an adequate and satisfactory Sewage Disposal System can be instaIled on this plot. Date Signed S-15 Revised 4/]/72 .APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATi;J S~4AGE DISPOSAL SYSTEMSi INSTRUCTIONS: Applications must be submitted in triplicate 1-Means Owner or Buil.der. Address to which mail should be directed. 2-Means detailed description of property location, together with street name an. distan¢ nearest intersection of m~fn thoroughfare, also Hamlet/Village & Township. 3-Ent.~r name of Public Water Supply District, together with the distance to the ir main. h-~hter Length and Width of Lot under appropriate heading, also enter these dim.~nsions center plot plan shown on the face of this application. ~-Name of subdivision. 6-Se orion number. 7-Lot number. 8-I~,ivate well: hhter "No" if Public water supply is available. Enter "Yes" o~herwise. 9-P~blic water: ,Enter "Yes" if Public water supply is available. ,Fnter '~o" o~herwise. PROPOSED S~STEM.$: Answer to Item number 10~ consult the Suffolk County Health ~partme~ ' Standards for Sewage And Waste Disposal STystems Design of Residential Subsurface Sewa Disposal Facilities. Part I-Residential Subsurface Disposal Systems covering cesspools. PLOT PLAN: The following information is required concerning the Applicant's lo~: 1., ~ size-Length and Width in feet to be indicated at the lot lines of the square in the center of Plot Plan shown on face of this application. ?. Surface waters-Streams, Lakes, & Bays, etc., located within a distance ofl. 1OO fee Applicant's lot lines, must be shown on the plot plan also. 3,, Wells and cesspools now on adjacent lots must be shown on the plot plan, Itogether the distance to the Applicant's proposed Sewage Disposal Systems and wsl~. ~. Where no buildings exist on adjacent lots, state "Vacant" on the plot pla~. ~. Streets adjoining applicantls lot to the right, left or rear, enter streelt name. WELL LOCATION: To locate the well & sewage disposal systems on Applicant's lo~, the fo Standards must be observed: Well-lOO feet minimum distance from the nearest cesspools. Well- ?_~ feet distance from rear and rear sides of property lines when pgssible. Well~ l0 feet distance from front, and front sides of property lines whe~ possibl Well- ~O feet minimum below grade for well point. ~¥ell- ~O feet minimum into ground water for well point. Well- h feet 6 inches minimum below grade to well head and lateral water pipe. C~SSPOOL LOCATIQN: Upon determination of the Sewage & Waste Disposal "%~pe of systems" 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 foundation.. 6-Cesspool exterior must be 1OO feet minimum distance from surface waters~ sSreams, & Bays, etc. 7-Cesspools must be 20 feet ~inimum 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 i foot to maximum o 2 feet 10-Bottom of cesspool to ground water ~st be held to minimum of 2 feet. to t~s ed of with ~lowing re- ~kes, MAP C,F P~PE P..'T Y' SU~.i'/'EY ED ;? COP tNOT~_-~,OTNO~ ~F ~TO"MAPOFFA,:~.VIEV/PA - · .= .... ._..._~_- ....... ...;. ..... L,t C E1~t.,'.'5 ED LAND TOWN OF SOUTHOLD ~ BUILDING DEPARTMENT,'/'"~'' TOWN C~RK'S OFFICE ~ xomined ...... L~..9.~ ...................... , 19~. . ~ D ~pprov~ o/c ................. ......... ' ........................ APPLICATI "ildi~Ins~t~GONFORBUILD~N PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, wi1 3 sets of plans, accurate plot plan to scale. Fee' according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, an: giving a detailed description of layout of property must be drawn on diagram which is pert 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 work. e. No building shall be occupied or used in whole or in pert fo~ any purpose whatever until a Certificate of Occupancy shall have bee~,~ granted by the Building Inspector. APPLICATION I$ 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 Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regurations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) Southo].d. ]i.Z. (Address of applicant) State whether applicant is owner, lessee, agent, amhitect, engineer, general contractor, electrician, plumber or builder~ ................................................... ............................................................................... Name of owner of premises ~,~.l~.e.~..h.. CO~...~..... 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 done. Map No.: .~..~X.~-.~.~. LP6~I~o.....,~. .................................... Street and Number ...........G~z~.:L~¥..,I~. ......... ~x~t:~to~ .................................................................................. dC;~/-~ Municipality :7. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ......... .T~f~J~l~.~..~,Jl~ ......... ~ ...................................................................................... b. Intended use and occupancy .......... gll~..~.JJ31eR]-l.:L~ ......... ~ ................................................................. 3. Nature of work (check which applicable): New Bui ding ....~ ......... Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... (Description) 4. Estimated Cost .........~...~.~.~ ....... ~ ............... Fee ..~..0.~...(~.. ................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ..~l~ ....... Number of dwelling units on each floor ......................................... If garage, number of cars ........~.o.......q~j~...lj~l~,~.....~l~ ................................................................................. 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. Dimensions of entire new construction: Front ......... ~ ..........Rear ...... ~. ................. Depth ....... ~1~. ..................... Height ................................................. Number of Stories ...... (~ ............................................................................. 9. Size of lot: Front ...................................... Rear .......................................... Depth .................................................. Height .................................................... Number of Stories ...................................................................................... 10. Date of Pumhase ..................................... Name of Former Owner ............................................................................ 1 1. Zone or use district in which premises are situated ...............~,~..J~Jl.1~ ................................................................... 12. Does proposed construction violate any zoning law, ordinance o~ regulation: ............ .~.~ ........................................... 13. Will lot be regraded .......31'~.~i ...................... Will excess fill be removed from premises: [ ] Yes [~ No 14. Name of Owner of premises ........ .~.Oaaixb...~ez~e3~ ....................... .~g37,.~],J[ .................................................. (Address) (Phone No.) Name of Architect ..................................................................................................................................................... (Address) (Phone No.) Name of Contractor ............~ .............................................................................................................................. (Address) (Pi)one 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 wheth- er interior or Corner lot. -4z--~-~ 3 ~t~""- - --, / STATE OF NEW YO R K~i3,~'O~ ~r COUNTY OF ...................................................... ) ........................................ h....c...o. .. .......................... /Name o/individual signing contract) being duly sworn, deposes and says t[at~he is the applicant above named. He is the ................................................ ...O1~.~.~.,,.,--,...~,.1[~..,~.~.~.~. ....................................................................................................................... ( Co~tractor, ~ge~t, coyote o[~cer, etc.) of said owner or owners, and is duly authorized to ~rform or have ~rfor~d the said work and to make and file this appli~tion; that all statements contained in this application are true to t~ ~st of his knowledge and ~lief; and that the work will ~ ~dormed in the ~n~r set forth in the application filed therewith. TERRI L[[ E~K HOTLY PUBLIC, State o~ New Yo~k .............................~'~'"'"day o,, ................ ~,m~'~"~[~'~'~9'~*:'''9 ' ~ _~mi ' ~ .~ '~ ;~ /'t~ ,~~ ~ Notary Public, .~ ................ ~ ......... Coun~ ...... ~_~..~......~ / (S~--..--..~-....f~~ ........................... II I ILo' /fL&" ,,' co,qc, F L iUD 7 ti" ~: I1" IlL6" ./ ii -I Jl tl jl II w/~.*.~a T° L_=S7'E~ coHa~; $M'~ET'p°'