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Home My WebLink About5864-zFORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy Map No.~.~.. Block No...~....)~...Lot No. ~.... ~.~../.~.. ~.. conforms substantially to the Application for B~ld~g Permit heretofore fil~ ~ ~is office dated ......~... dated '~ ~ 19~ was ~su~, ~d confoms to ~1 of ~e r~u~ ments of the applicable pro~siom of the law. ~e occupancy for which ~ ce~ifica~ is issued ~.. ~~:~:~..~.~~...~ ~ ............... The certificate ~ issu~ ~ ...~...~.~ .... ~ ........... (owner, lessee or ~n~t) of the ~ores~d Suffolk Co~ty Depa~ment of He~th Approv~ . ~. o~o~w~v~s C~V~CAT~ ~o..~.ff,~.~,~ .... ~.~..~ ~. >. ~ ........... Building Inspector FOR~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CO~MPLETION OF: THE WORK AUTHORIZED) N? 5864 Z Permission is hereby granted to: ...... ot premises ,o~oted ot ............................... .~.~.]. ...... :~.~/~......~: ...................... .................................................................................. C~ ~.'~ ~" ' '/J~'-'t~tffJ' '~~t~u~''~''' ....................................... pursuant to application dated ............................... '-~'""/'~'~"~i/""' 19./:.~.,,.gnd approved by the Building Inspector. Building Inspector SUFFOLK COUNTY DEPARTMENT OF HEALTH . EASTERN DISTRICT,RIVERHEAD,N.Yo H. D. Reference No. ~S~ APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Date A Approval to construct said systems is requested,pertinent data herewith: Address ~,~ Y~ ~ 2':.~ ~;'~. ~.~~, /~/, ~ ?-Section 2-~eta~led property location ,~?/~ ~J. ~/~. ~ 8-Lot No. Distance to nearest main 3-Public ~ater supply n~ame ~-Lot size: Length ~ft, Width /s~ft, (Also enter on center plot plan below:) - enin : s le /eerier?/ /Crawl Sp ace?/ lO-Proposed system:Septic tank/)f/Precas~t~Cesspools~_/S~, peols/~/other/ / Il-Septic tank inside dimensions:Volu~e ~Gals,Length,.~Jt,Width_~ft,Liquid depth ~ ft, 12-Precast sections:/~/N~ber,//~o/Square ft,Cesspools.Block sizeL,/$ins..D ~ ins,H ~ins. PLOT P~N Capacity ~4Gals Street Indi .at~ No ~th Test Hole Data ~eet ~ 2 lO 16 The Undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Health Departments' current Standards,Bulletins, and amendments thereto,covering Private Sewage Disposa% Sy~s~ems~". ) Owner or Builder FOR HEALTH DEP~iT~NT 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 ~/~/?~ Signed ~'''~- 10/65 East TOWN OF SOUTHOLD /~-~'~ BUILDING DEPARTMENT,, TOWN CLERK'S OFFICE /~ SOUTHOLD, N.Y. ~ Exomined ........................................ , 19 ........ ~ ~pr~e~ ........................................ , 19 ........ Pemi[ ~o...........Z~6~..........,.,.......,..~ Disapproved a/c (Building I nsp~ctor) (f applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) So? / 1. Location of land on whic~,proposed<wo~'k~will be.done. Map,No.: ....,,. , Lot NO ............................................ ~Vi..' k't/ .~:. ~/r,f.: ';' V,~'. ..,~ ~ ~. ~. ~:,~'., .Z ,~. . :',, .' ,..,~ ~ V. ..,,.,r t.; ' . .' Street and Number ........................................................................................................................................................ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ............................ ;: ...................... .~.~. ............................................................................. b. ntended use and occupancy ........... .~. ......................................................................................... APPLICATION FOR~/UILDING PERMIT 72_ Date ................................................ , 19 ............ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, wi 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Pict plan showing location of lot and of buildings on premises, relationship to adjoining prem see or pub ic streets or areas, an~l'~ giving a detailed description of layout of property must be drawn on 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 perm t shall be kept o~ the premises available for inspection throughout 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 granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department~ for the issuanceof a Building Permit pursuant to the Building Zon~ Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construct on o~ 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 regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections.! (Signature of applicant, or name, !f a corporation) State whether applicant is owner, lessee,(aOP,~,, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ................................................................................................................................................ ' - 3. Nature of work (check which applicable): New Building ....................... Addition ..................... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... 4. Estimated Cost .......,..~.,.~..,..~...-r .................... Fee ......... LZ...: ................................................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ................. Number of dwelling units on each floor ......................................... If garage, number of cars ............................................................................................................................................ 6. If business, commercial or mixed occupancy, speclfy nature and extent of each type of u~e ..................................... 7. Dimensions of existing structures, If any: Front ..................... Rear ........................... Depth ................................... Height ........................................................... Number of Stories ............................................................................. Dlmen,lons of same structure with alterations or additions: Front .......................... Rear ......................................... Depth ............................................. Height ......................................... Number of $torlag ........................................ 8.. Olmanslonl of entire new conltructlon: Front ........ ~',,G,; ........... Raer ......... ~,, ................ Depth ................................. /ir° " e,~.~.. [ ............................................. HeIght .............................. ,-6,,, .............. Number of ................................................... 9. Size of lot: Front ........... (,,P,,~, ................ Rear ............ ,/,,,~, ...................... Depth ............................ .,,.,, .............. ,.I0ht .................. Z~..: ........................ ,~ Number o~ Storl,, ............ Z. ................... ,,,, ................................ , .............. 10. Data of Purchala ......a/.,~,.,,,,~.,,, ............. N m of Former Owner 11, Zone or u. dlgtrlct In which pramlm ar~ gltu,tad ................... , ................... ,,,,,,,,,,,, ...... ,,,,,,,,,,,,,,,,,,.,,,,,,,,., ...... ,,,,,. 12, Do~g propo#d aongtruatlon vlolata any lonlng law, ordinance er regaletlem ,..,,~,,~,,,.,,,,,,.,,,..,,,.,.,,,,,,,,,.,.,. 13. Will lot be ragredad ...... ,,,.~(~ ...... ,, ...... Will ,xa,,, fill be mme~d from pmm~,~ ~ ~ Ye, [~ Ne 14, Name of Owner of pLOT DIAOI~AM Loee~o clearly and di,~inotly ,11 buildingm, whotho~ o~i~i~ o~ ~m~o~, ,~ i~di~,~ ~11 ~G~ ~imo~iom f~m prop.~ linD,. 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