HomeMy WebLinkAbout6300-z FORM NO. 2
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, FI.. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N9 6300 Z
Permission is heresy gronted to:
St~nl~F...Co~.~,r~r..&t~.y.,...A%.C..t~.i~..RaYmond I II
.Gtreen~or~ .. .
~o ...... ~!~...r~w,..g~...~:~m~l~:..dw~.~g.....~,~%.~..~g~,~,)....~ ........................................
· o ,~ ~T
~.st Green~ort Gr~,en~o~
pursuent to opplicetion doted ...................... ~Og ....... .~.0 ......... ;...., 19.~.., ond opproved by the
Building Inspector. '~'
Fee $.28.*.~0 ...........
APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE S~WAGE DISPOSAL SYSTEM
M77-1~.L~ Subdiv.
1. Applicant l~vw~'~ Ra~o~O /IL-' Phone .... 6. Section
2. Prope~ lqc~ion f~o' ~J~ ~ ~mmWE~ ~m~_7. Lot No.
3. Public Water Company ~ame ~~~ pistance to main. ~gt bflow~
4. Lot size: Width ~7 feet Length ~ feet (Enter on center
[0. Sewage Disposal System:
A. 900 gallon septic tank: Precast E~ivalent__Block
B. Leaching pools: Number~Precast'" Block ...Special
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
4
6
8
10
12
14
16
18
The undersigned ERTIFIES: onstz L~ed installations will
the Suffolk County Depa~tme'nt of H~lth's current stand-
be
in
accordanc~
with
ards theret~ ~ ~tz~~ /~
Date "~/
' ~wnar or Buil
FOR HEALTH DEPARTMENT USE ONLY. Based oD the tnfdrmation presen ed herewith, it
is the opinion of the .Health Department, that an iadequa~? and satisfactory. Sewage
Sys can be installed on this plot.
Disposal rem
Date
Addenda So Application of Lewis RaymondI III
The immediate' purpose of this application is to obtain an
inspection of an existing cesspoo~hich is presently used only for
the washrooms in a service station building,land which, on a temporary
basis, the applicant would like to use for a! (mobile home) residence.
If the existing cesspool is deemed inadequate for permanent use
by both the washrooms and the mobile home residence, additional
cesspools will be constructed.
The property is in an area rife with clay lenses.
BUILDINQ DEPA~.TMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Disapproved o/c ..........~......~ .... ~ __
APPLICATION FOR BUILDING PERMIT '
Date .......................... ..~.. ......................... ,
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Buildi~-~
Inspector.
b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets ~-
areas, and giving a detailed description of layout of property must be drawn on the diagram which is POrt of this applicat?~
c. The Work covered by this application may not be commen(fed before issuance of Building Permit.
d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such perm:
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 Occupar~,
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 th.;
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o~
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 an~
(Signature of al~'plicant, or name, if a corporati~'n) '
.............................. ';f' 'c ..........
· State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or buildei'.
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officer)
1. Location of land on which propCed work will be done., Map N~3.;~ ........................... Lot No ' .,
2. State existing use and occu~ncy of premises and intended us~ond occupancy of proposed con4tru~Ction:
3. Nature of work (check which aiSle, able): New BuiJdl~ .~ ................ ,e~Jltl~ .............
(to be paid on filing this application) ,
5. If dwelling, number of dwelling units ....... ...... . I..............Number of dwelling units on each floor ....................... ; .... i
If garage0 number of oars ............................................................................... , ............................................
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 ....................................................................................................... ; ......... i_
Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ ,:
I
Depth ................................ Height ............................ Nu~b~9~, Stories ......... '~"' ~"'1 .............
I I. Zone or use district in which premises are situated ................................................ ~....-.-L.. .........................................
12. Does proposed construction violate any z.~nlng law, ordinance 9r regulation? ....... ~A~"~.~......--:w~.. .........................................
13. Name of Owner of premises . ..~.. ......................... '..~l,~...~Address ............................................ Phone No .....................
Name of Architect ..... '"~_ ~2~'~ ................ Address ............................................ Phone No .....................
~'~ -- Address
Name of Contractor ...~.....~...~ ................................................................................ Phone No .....................
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or p..mpasad, .ancO, indicate all let-back dimemions from
property lines. Give street and block number or description according to deea, and show street names and indicate
whether interior or corner lat.
STATE OF NE~"~.YOIJlf~, ~ j~. I c c
COUNTY OF
........ ......~.. ;~.~....~.......E~..~...%Z~...~...~. ~ ....... ~ing duly ~orn, d~ a~ s~s t~t he is the opplicant
(Na~ of indivi~al s~iDg appl~a~ ~
above name. He is the ......... g,L~...~.~.L~...~..~ ..................................................................................................
(~ntroctor, agent, co,rate officer, ~c.)
of said owner or c
this application;
that the work will
Sworn to before
Notow P~c,.
~, and is duly ~horized to~erform or have performed the said work and to ma~e and file
I statements ~ontained in th~s application are true ~o the best of his knowledge and belief; and
erformed in th~ manner set f,g~th in the a~lication filed therein.
n,s ~ / ..~ ~
............... ........ ...................
~m~on ~plr~ March 30~ t~ ..... /
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