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Home My WebLink About5890-zFORM NO. 4 TOWN OF $OUTHOLD B[TIT.DING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ,Z~..~..~..6. Date ~ / ~/ 1~' THIS CERTIFIES that the building located at'ii~' .~. i '.~. Map No ..... X ...... Block No..~ ....... Lot No..~~.. ~.~. co~orms subst~tially to the Application for B~ding Pemit heretofore filed ~ tMs office ..... ~../. ~. .... , 19~ p~u~t to which Buil~g Permit No. dated dated ....................... , 19 ...., was issued, ~d co~orms to ~1 of the req~e- ments of the applicable pro~sio~ of the law. The occup~cy for wMch this certificate issued is .~: .~ ..... ~.~.'~. ~.c..~... [C .~.) ........ The ce~ificate is ~sued t~...~... ~ ...................... ~ (o~er, lessee or ten~t) of the Mores~d bulldog. S~olk Co~ty Depa~ment of He~ Approv~ .... ~.,~ .' ........................ UNDER~ITERS CERTIFICATE NO ..... ~ HOUSE NUMBER... ~ ~ ~ .... Street... ~... ~.~ ..................... ll'O~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5890 Z Permission is hereby granted to: #~1~a~ 8~a es , G ove~' ................. v.L:.....Z..~ ....... ;b ......................... to ..... ~a~.3.&.~:..~n~...£,~'.'W...P,~.e/Z~,g ................... .(...&T~p~':e~.~...b~...~...A,.~e~l#). et premises located at ..... .~,~l....~.g3L~t~#l .......................................................................................... .................................................................................. C~telaelae.....]i.~. .......................................... pursuant to application dated ........................... ~11~'.~.9 ................ , 19..~..., and approved by the Building Inspector. Fee $.....~.*.0~ ....... -- Building InsP7 SUFFOLK COUNTY DEPARTHENT OF HEALTH AP~ICATION ~R AP~ TO ~NSTRU~ PR~ATE S~AGE D~SAL SY~E~ ~te~. Approval to co~t~ct said systems is r~uested,pertinent data here~th: 1-Applicant ~u~ ~, otaplem ~one66$-O~96-Sub div Address 6959 ~ L~e 7-Section 2-Detail~ p~pe~y location ~/~ ~ ~ g¥ ~g ~'~/~ ~t No. ~mlet ~t~e To~ ~1~ ~ 9-Private well? 3-~blic ~ter supply ~me Distance to nearest ~in 4-~t Size: Width l~ggt. Length~ ft. (also enter on center plot plan below:) 5-~elli~: Single Family ~ T~ F~ly? ~Cellar? ~lab? ~ JCrawl S~ce? lO-Pro~s~ ~stem: Septic tank ~ ~Precast JxYCess~ols ~Shallow ~ols Y YOther il-Septic tank inside dimensions: Volume 12-Precast sections: /~Number~_/Square Total blocks below inlet: ~1 g~O~2 (~0~3 PLOT PLAN Vaoant 179 ' Street ~x Lane Vacan~ Capacity ~Als. G.P.M. ~- 500 t Indi No --N :ate 'th Data Feet 0 2 4 6 8 10 12 16 18 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. Se~e %isposal~v~yste~s".. Date Ja~, 14~ 197Z Signe~ .~ ' Owner or FOR HEALTH DEPART~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. (10/65 Revis.) S-15 Gals.Length__ft. Width' ft. Liquid depth ft. Ft. Cesspools: Block sizeL___incs.D ins. H ins. APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS INSTRUCTIONS: Applications must be submitted in triplicate i-Means Owner or Builder. Address to which mail should be directed. 2-Means detailed description of property location, together with street name and distance to nearest intersection of main thorofare, also Hamlet/Village & Township 3-Enter name of Public Water Supply District, together with the distance to their main. ~-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-Dwellings: Check-mark "V" items applicable to the proposed new dwelling. 6-Name of sub-division ?-Section Number 8-Lot Number 9-Private well: Enter "No" if Public water supply is available. Enter "~es" otherwise. PROPOSED SYSTEMS: Answers to Items number 10, 11, & 12 please consult the Suffolk County Health Department's Standards, Bulletins and Amendments for Sewage & Waste Disposal Facilities. i.e., Part II-Residential Sub-surface Disposal Systems covering Cesspools Part III " . . . . u Septic Tanks Part IV " " " " " " Unusual soil conditions Part V " " " " " " Shallow Leaching Pools PLOT PLAN: The following information is required concerning the Applicant's Lot: ---~'L~-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. Surface wabers-Streams, Lakes, & Bays, 'etc., located within a distance of 50 feet of Applicant's Lot lines, must be shown on the plot plan also. Wells and Cesspools now on adjacent lots must be shown on the Plot Plan together with the distance to the Applicants p.rOposed Sewage Disposal Systems and Well. Where no Buildings exist on adjacent lots~,~ state "Vacant" on the plot plan. Streets adjoining applicant's lot to the right, left or rear, enter street name. WELL LOCATION: To locate the well & sewage disposal systems on Applicant's lot, the following Standards must be observed: Well-100 feet minimum distance from the nearest cesspools Well-25 feet minimum distance from rear, and rear sides of property lines Well-10 feet minimum distance from front, and front sides of property lines Well-50 feet minimum below grade for well point Well-40 feet minimum into ground water for well point Well-4 feet 6 ins. minimum below grade to well head and lateral water pipe CESSPOOLS LOCATION: Upon determination of the Sewage & Waste disposal "type of systems" required, the following Standards must be observed for the location of same: Cesspool-10 feet minimum distance from lot lines to center of cesspool Cesspools exterior must be 100 feet minimum distance from nearest well Septic tank exterior must be 75 feet from nearest well Cesspool "Center" must be 12 feet minimum distance from nearest water line Cesspool "Center~ must be 15 feet from house foundation Cesspool exterior must be 50 feet minimum distance from surface Waters, Streams, Lakes & Bays, etc. Cesspools must be 20 feet mininmm distance from large trees Cesspool center to Cesspool center must be at least 16 feet Cesspool cover top to grade must be held to minimum of 1 food to maximum of 2 feet Bottom of Cesspool to ground water must be held to minimum of ! foot BUILDING DEPARTMENT~ TOWN CLERK'S OFFIGE - SOUTHOLD, N. Y.~ ~proved .................. ( /~ ................ , 1~ ............................................ Dis~p~rovod ~ .......................................... ............. ................................. APPLICATION FOR BUILDING PERMIT Date ............. .~.~...,,,.., .................... , 19.J ........ -- 1 NSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the BuildingS,r 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 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, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. : . ........ ...... :..:.r. ........... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises r , , -~, ..~ . , , ... 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.: ........................................ Lot No ......................... Street and Number .... ,.,;..::~...:../.:~..*..IJI...!~4..,.'.~'~ ........................................................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: Exisiting use and occupancy ................................................................................................................................ 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 ....~ ........ 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, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number"0f Storie~ ................................ 8. Dimensions of entire new construction: Front .......... .~..:..~... ................. Rear ......~'.....O. ................ Depth ....~........~.. ........... Height .................... Number of Stories ........... ~ .............................................................................................. 9. Size of lot: Front ...~....~...~.....~...... Rear ....... ./...~....-~....~....~.. ........ Depth ........ ..~....~ ........... 10. Date of Purchase ........................................................ Name of Former Owner ..... ~ ............................. 11. Zone or use district in which premises are situated ........ ..C~...~..../. .................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ....................... 13. Name of Owner of premises ........................................ Address ............................................ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Nome of Contractor .................................................... Address ............................................ Phone 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 whether interior or comer lot. STATE OF NEW./~'OJ~.K, /~ ! c e COUNT~ OF ~ ....... $'~'~ ....... ~~~..'~.. ..................................... bein~ duly sworn, d~oses ond soys t~t he is th~ opplicont / (Name of individual signing application) above named. He is the ......................................................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set fo~h in the application filed therewith. Swam to ~ me this -- .~' ddy of ~.~ , N~aw p~~~~... 1.~,, County9'~"~~(Signa~re'. ................. No, 52-0344903 Suffolk C~unt~ ~4-o Lr-s_ 19_ ' ¸:1 II · App~o¥~ T~^pLDr