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Home My WebLink About6035-zTOWN 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? 6035 ' Z Permission is hereby granted to: · .'~'~'""E~'~%':~rv'"~:?:~-~ ...................... : ................ ....... ~,~:. ,..r~¢,:.I.~ ....... .1~.,.~..~ ..................................... ~o ·. ~t ~ ,.~¢~W. · .omc ...f, ami ~5. -. ~,~,.e.~. t.z.r~g. .......................... ? ........................................................ at premises located at ....... ,tw+,w..,~..:~:...~....~t~...(~.~]L,.~,~J:.:L~..&..O.~he:~ ......................... ...................................... ~Tt;~'""$'t: ~' ,v ~ t: .............. '~; ~'~'2 ~ 2' .......... '~ ........................................................ pursuant to application dated .. ....................... ~'.B'J.-? ........ .~l...i ..... 19...~1~., ond opproved by the Building Inspector. ,- Fee $.~1~.¢-~ ........... , w '~"Building Ipspector , J SUFFOLK COUNTY DEPARTSENT O7 EALT M.D. Reference No. ~-/z~5 APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM 1. Applicant [ __Phone ]5. Subdiv. Address - 6. Section 2. Property location 7. Lot No. 8. Private well Village · Township___--,~ , ,~,9' Public water 3. Public Water Company name Distance to main 4. Lot size: Width feet Length feat (Enter on center plot 10. Sewage Disposal System: A. 900 gallon septic tank: B. Leaching pools: Number_ Precasl__ Street be ards Equivalent Block Block Special FOR HEALTH DEPARTMENT USE ONLY. below) If private well fill in blanks below: Tmnk capacity Gals. Pump G.PoM. 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 CERTIFIES: "Construction of in accordance with the Suffolk County Department of Health's current stand- thereto." ~. ~'~ ~?~'/ ~ i~..?~' ~ Date z ~ Signed ?~ ' . Owner or,Builder --Based on the infprmation presented herewith, authorized installations will it is the opinion of the Health Department, that an adequate and sat~i~-~ctory Sewage Disposal System can be installed on this plot.~ .... ~ ~ S-t5 Revised 4/1/72 APPLICATION. FOR APPROVAL TO CONSTRUCT PRIVATe; S~.WAGE DISPOSAL ,SYSTEMS INSTRUCTIONS: Applications must be submitted in triplicate 1-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 ma~n thoroughfare, also Hamlet/Village & Township. 3-Enter name of Public Water Supply District, together with the distance to their main. 4-Er~ter Length and Width of Lot under appropriate heading, also enter these dimensions on center plot plan shown on the .:['ace of this application. 5-Name of subdivision. 6-Section number. 7-Let number. 8-Private well: ~hter "No" if Public water supply is available. Enter "Yes" otherwise. 9-thtblic water: Enter "Yes" if Public water supply is available. Enter 'No" otherwise. PROPOSED SYSTEMS: Answer to Item number 10, consult the Suffolk County Healt~ Department's Standards for Sewage And Waste Disposal Systems Design of Residential Subsurface Sewage Disposal Facilities. Part I-Residential Subsurface Disposal Systems covering cesspools. PLOT PLAN: The following information is required concerning the Applicant's lot: 1.. tL-~size-Length and Width in feet to be indicated at the lot lines of the heavy lined square in the center of Plot Plan shmen on face of this application. 2. Surface waters-Streams, Lakes, & Bays, etc., located within a distance of 100 feet of 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, together with the distance to the Applicant's proposed Sewage Disposal Systems and well. 4. Where no buildings exist on adjacent lots, state "Vacant" on the plot plan. 5. 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-lOO feet minimum distance from the nearest cesspools. ~ell- 25 feet distance from rear and rear sides of property lines when possible. Well- l0 feet distance from front, and front sides of property lines when possible. Well- 50 feet minimum below grade for well point. Well- 40 feet minimum into ground water for well point. Well- 4 feet 6 inches minimum below grade to well head and lateral water pipe. CESSPOOL LOCATION: Upon determination of the Sewage & Waste Disposal "type of systems" re- q~ire~, 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 100 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 lO feet from house foundation.. 6-Cesspool exterior must be lOO feet minimum distance from surface waters, streams, lakes, & Bays, etc. 7-Cesspools must be 20 feet minimum 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 of 2 feet. 10-Bottom of cesspool to ground water ~xst be held to minimum of 2 feet. FOItM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMEN? TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved~'.. .................................. 19 ........ ~' Pemit No~-~C3 > ~ ~ ....... Disapproved a/c ..................................................................................... (Building Ins~tor) Application No..,..~...~..~..~.'...~.. ........ APPLICATION FOR BUILDING PERMIT a. This application must be completely filled m by typewriter or in mk and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buddings on premises, relationship to adjoinir~g premises or public streets or areas, and giving a detaded 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 ~f Building Permit. d. Upon approval of this application, the Building Inspector wdl issue a Buildin~ Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shah be occupied or used in whole or m part for any purpose whatever until a Certificate of Occupancy shall have been 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 coda, and regulations, and to admit authorized inspect?rs on premises and in buildings for necessary inspections. (Signature of apphcant, or name, if a corporation) ............. ................. (AddreSs of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ~3.~:~[>L.~t~.~£~[~.~.~.~.~.~.~?`;~:~.~.~;t~..~.*~; ............................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work wil. I be done. Map No.: ....... ~ ............................................. Lot No.~....~..+..~..? Street and Number .~'.~.O.~.~..~,.o....,.~.~..~..~'~<.~.~.. ............................................................................................................ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a, Existing use and occupancy ................................. ~.~),~,~,'~,~,,,.~,., .............................................................................. b. Intended use and occupancy ................ ~-.~.~..m..~ ...... ~..~.:~..~ ....................................................................... 3. Nature of work(check which applicable): New/Building ................... ;... Addition ..................... Alteration..i~'.. ......... Repair ............. - ............ Removal Demolition .................. :..... 'Other Work .................................... ......................... {Description) 4. Estimated Cost ............................................... Fee .,~...~..!..~....~......'....; ....... ; .............................................................. (to be paid off filing this application) 5. If dwelling, number of dwelling units .....~.. .......... Number of dwelling unit~ on'each floor ......................................... If garage, number of cars .............. .~.....~..~.,~.......~.;..~...~...~...~. ................................................................... ~,xj~J . .. 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 ......-~.4..~ .................. Height ........................................................... Number of Stories ............~.. .............................................................. Dimensions of same structure with alterations or additions: Front ......... t...~'. ........ Rear ........ ~...~......~. .................. Depth .......... ~.~....~. ...................... Height ......................................... Number of Stories ............. J~ ......................... 8. Dimensions of entire new construction: Front . .~...~..~.~...~ ......... Rear .....~...~....~ ............ Depth ....~.(~.....~. ................ Height ................................................. Number of Stories ......................................................................................... ¢.. ( '0 9. oize of lot: Front ....~...~...~:...~... ................. Rear ......... /~.~...-'....-,?.....~.. ...... Depth ................ ..~.. ............................. 10. [)ate of Purchase ...~.~...~.~.!..~.')..! ......... Name of Former Owner ..~..1~..~..~..~.~.L~..~-......~.Y~.~.~.~...5.......~..~.' .... 11. Zone or use district in which premises are situated ................................................................. :....'. .............................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ......................... ' .................................... 13. Will lot be regraded ................................ Will excess fill be removed from premises: [/] Yes [ ] No ~ ,~ Name of Owner of pram ses (Address) (Phone No.) Name of Architect ................................................... ; ................................................................................................. Name of Contractor ~ ~'i~.~..~.~....~[1.I.l,. ..~.....~.IE~.; ...... (~,~...~i'~. I{~., ................. " (Address) (Phone No.) PLOT D,I,AG RAM I.ocate clearly and distinctly all buildings, whether ex st~hg~or proposed, and mdmate ail set-back d~menslons 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. STATE OF NEW Y~~ ) COUNTY OF '"'7'-'7~' ......................... ) ~S' .......................................................................................................... being duly sworn, deposes and says that he is the applicant above named. {Name of individual signing contract) He is the ................................................................................................................................................................................................................. {Contractor, agent, corporate officer, etc.} of said owner or owners, and is du~ aut~ b~iz~'~ t/o ~erform or have performed the said work and to make and file this application; that all ..... wol~,h', '{~le ta ~t of his knowledge and belief; and that the work will be performed in the manner statements contained m th~s apphc~a~,,~r~ set forth in the application filed tfl~r~wJ~, '~ ~J/~",'r- No~ y~ Z ............... .............. ........ Notarv Public,~..,-..., nty / o~ I:--I -It/~i w I ~0o~1 FL 001~I PL~ ;~ 2"X co,lc, FL : R. IGHT ~IDE ~JJNGL~D LI F R E p I /,CE D ET~ILS , ,_SECTION yERTICAL ~E"O. G. MOR. ~UILT-UP Roof FLOOR <®-, , --- -I -4' I, i Ill