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Home My WebLink About5790-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. N? BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 5790 Z Dote ................................ ~....~. .............. , 19...~... Permission is hereby granted to: ~tlvex's~.~te T/o. s A ............................. ~ ....... ~..~..~,...~, at premises located at ....... Jl~O,ll[....O~'~..~...$¢.llt,~...~.![~1~r..~.~.e .............................................. ......................................... &m~mle....~'~ ....... £apl~..~,~.~) ........................................ pursuant to application dated ........................... ~.~l~i.[.....l+ .......... 19.~.., and approved by the Building Inspector. SUFFOLK COUNTY DEPARTMENT OF HEALTH ;,P~?~'?9" CO~:STKUCT~ F~R~Fgr~Ti~EWAC~Dr~POSAL.SYSTE~.~ ~/~ ~ /~ , ............... ccn~:~t s~id systems is rcc~ucstcd,pertznont data hero,th: ~z ,, ,, supply n?~9 Distance to nearest main W'dth//O_ .j~__ft,. ~ngth~f~.'~ (also enter on center plot plan belou:) . ?mily Sin:'le ~ste~: ocptic t~k in~ide~mcnsions: ~f~]_um~ Oals.Lcng%h f~. Width ft. L3 u~d d~th ft. be,ow inlet. ., PLOT PLAN ' ' 7 C~F' ~ty! 3~ls. -1 Indi ~te No ~h ike Undersigned CERTIFIES: "Construction of authorized installations wil~ be ~n aocor/~]nce with the Suffolk County Health'Dep~rtments' current Standards, Bulletins, J 0 and am~r~nents thereto, covering Private Storage Disposal~S~stemsT,. ~?'J2~..f_&..~ ~10~::~:~ ~.~. ' 2~te ~ ' Sign~ ~e~ p~S o~NT P 0 o i m- D, 11 02 FCR E~%~LTH DmPARTb,~,,T USE ONLY. Bas~ on the infomnation presonted here~th, it is th~ opinion of the Health D~pi~ment, that an adequato-and satisfacto~ Se~e Dis~sal csn b3 ~notalled on this ~ot. D~te ~/~ Sign~ C FORM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLEI~K'S OFFICE SOUTHOLD, N. Y, Approved ...................................... , 19 ........ Permit No ................................. Application No......~.?.~ ~ ......... Disapproved a/c ............................. ~ ....................... APPLICATION FOR BUILDING PERMIT Date ................. ................... ... INSTRUCTIONS o. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building inspector. b Plot p!an showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drown on the diagram which is part of this applicatMr- c The work covered by this application may not be commenced before issuance of Building Permit. u. Upon approval of this application, the Building inspector will issue a Building Permit to the opplicc~,~t Such ;~erm,t shah 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 Occuponc~ 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 applicable Laws, Ordinances or Regula ~or:s, 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, or,~ances and regulaJ'io~. ~ · I (S'gno ure of applicant, or name, if a corooratic ,~ · (Address 9f applicant) / /, · '/ ~ , / ~ .................. ~. f~. M 6~..G:.C~': .~ ........ ~( .~.'. .f ....................................................... Name of ~ner of premises ...... ~ ~......~.....(......~.~J~ If ar~i-~,-ant is a corporate si;ingture of c~uly authorized officer. I (Name and title of corporate officer) Location of land on which proposed work will be done. Map No: ...... ~.~.~.~..~.'~....~"../../~...'~f.~Lot No: ...3 ............. Street andNumber ~.~./~' .~.?./..~../Cd~...(~ ~0"* ~--".,,~....~.. ~'~2,4,,/~ /.,,','~,1,/ /q 7'~ ~'~Z~-~-~'~ p~J/~.z2-- Municipality -- -~'~)r-~" '~'~'~.~'~ ......................... State existing use and occupancy of premises and intended use and occupancy of proposed construction a. Existing use and occupancy ........... .~.. Z~.. · .~-. Z~....~. ·...?.....~....~,..~......:~,.~.. ........................................ b. Intended use and occupancy ........ /i ....... ..~.......~....~ ./....~-r......~... ........... ~.......~... I~,...'-~...~:......C~...~...~.. ,~.. ~TT'~' ....... property lines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. 3~ Nature of work (check which applicable): New Building ....~... ...... Addition .................. Alteration ................ Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4 Estimated Cost ........ /~... ~...o...O......L.. ............................ Fee ....................................................................................... · (to be paid on filing this application) 5. If dwelling, number of dwelling units ........... ~ ..............Number of dwelling units on each floor ....... ~z: ................. If garage, number of cars ............................................................................................................................................. 6 If business, commercia~ or mixed occupancy, specify nature and extent of eac~!~ry/P~e of use ............... ; ............... 7 Dimensions of existing structures, if any: Front .... /¢/ ~, '' Rear l .~......i'~' ............. Depth ....... :~..Z...~....~.i... Height . Number of Stories ................ L. ......................................................................................... Dimensions of same structure with alterations or additions: Front ................................ Rear ............................... Depth ............................ Height ................................ Number of Stories ........................................ 8 D,mens,ons of ent, re,pew construction: Front ............ .~.~ ........... Rear ........ ~ .~.....~. / Depth Height ........ ,,~.~. ......... Number of Stories ......... ./..~"~..)-rr~... ......... ' ........................... 9 Size of lot: Front ...... /Z...~.. ........ Rear ........~'./..~ .......... Depth ......... Z.-'~.......(~.. ................. 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ ]1 Zone or use district in which premises are situated ................................................................................................. 12 Does proposed construction violate any zoning law, ordinance or regulation? ...................................................... ..7. ......... ................. ;; ...... 13 Name of Owner of p rem ses Z~/I///_.) , /'/44:~ Add ress ../~...~..'(#.....~...'.....~..,~'-~.~'.. Phone No ................... Nome of Architect ... . Name of Contractor~'2..~.~.~i'./~?~...~...~..~..~"~../..~A~J;dress ~"~'~"~'~'~L' '/"L"~"~"~"~"'~'"'~'?~",/~'//'~_..//~-,,~,¢2'" Phone No PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-b~ck dimens,ons from STATE OF NEW YORK, ) COUNTY OF ............................ ) S.S. ............... L. .~ ~...~ ..................... being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ..................................... ~..¢.~.'....'~fr~... ....................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authdrized to perform or have performed the said work and to make end file this application; that all statements contained in this application are true to the best of his knowledge and belief; ,3nd that the work wilt be performtlct~b~-ftl:ll~H~ner,,s.e~: forth in the application filed therewith. Sworn to before me this ..... '~/ ........... ~~d~~:'~r"~:2'~"r~'"~R~ ' ,'/ ~- ' ¢''{ Z" / - ~ , .z - ......... i: ...........,: ............ ~.~,'....',...,~..,..~-~,~; ......................... Notary PubJ'i'c~.<:'~uur~tv (Signature of applicant) N / Z F.'~ L) L. i-I,,:~ /'~ S