HomeMy WebLinkAbout7673-zNO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Ot~ice
Southold, N. Y.
Certificnte Of Occupency
THIS CERTIFIES that the building located at ~a. DS* Street
Map NoD~el~. Ro]Le. I~lock No ........... Lot No..61. ...... l~la'l~t;tt~uQ}~..I~oY, ....
conforms substantially to the Application for Building Permit heretofore filed in this office
dated .......... DZO...27...., 197~. pursuant to which Building Pe~it No..
dasd ............... ~...~0, 19..~, was issued, and confo~s to ~1 of the requ~
ments of the a~plicable provisions of the law. The occupancy for which this certificate is
issued is . ~V~. 0~ .$~lY. ~w~.~ ......................................
The certificate is issued to . ~9~0~. ~a~k. H~ ~o .........................
(owner, lessee or ten,t)
of ~he afores~d building.
Suffolk County Department of Health Approval . ~, ~ .~7~.. ~ .~?. ~%~. ....
UNDERWRITERS CERTIFICATE No.. ~2~;83~6. .... A~l~..$S~..~.97~. ............
HOUSE NUMBER .... ~6~ ..... Street ...D~ .D~, ............................
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
Health Services
Reference
10.
ll.
APPLICATION FOR APPROVAL TO CONSTRUCT
A PRI.VATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY
Applicant 'JT~c. Phone Z~'~-Z-~- 5. buooiv.
Address ~0 L¢~ ~o~ '6. Section
Propert~ Location ~'~sf~-~ ~o~mm ~i~~-- ~. Lot Number
Vi 11 age, ~4 a '~/-, ~Q{c Townshi p~ u~! ~
Public Water Company .N~me
Lot size: Width //~'~_feet Length~feet
8. Private Well
~. Public Water_~o
DiStance to main
Sewage Disposal System:
A. ~O0~gallon septic tank:
?recast_]~__Equi val ent B1 ock
B. Leaching pools:
Number of pools
Precast?_~Block.
If private well, fill
lowing blanks:
~pecial __
in the fol-
A. Tank capacity ~ gallons
B. Pump G.P.M.
C. Total well depth
Do Depth to ground water
E. Amount of water in well
(For Health Services Dept. Use__)
The undersigned CERTIFIES: "Construction of authorized installations will be in accordance
with the Suffolk County Department of Health Services' current standards thereto." This
application will be valid for one year from the date of approvall indicated below and may
be renewed if a current local Building Department Permit is in effect.
Date__ __ ned
FOR THE DEPARTMENT OF HEALTH SERVICES' USE ONLY. Based on the information presented here-
with, it is the opinion 6f {he Department of Health Services that an adequate and satis-
factory Sewage Disposal System and Water Supply can be ~nstalled on this plot.
APPROVAL DATE .~.~/~/~f'~.,, SIGNED C ~ ,~ ~-
S-15
Rev. 4/1/73
.~ , ~ : ~reo=2~5?2
Lot GO
so,age disposal and ~a~e~uppiy :
fScilit~es for this loc~tio~ h~ve been
tnspoeted by th~s department;
C~~ns :
Lot 5G
lot 57
n,~v,$ioNs ~UNG &i YOUNG
JU£~10~1975 ALOEN W. ?OU~ :, ~ HOW~D W, YOUNG
~ ~~~, ~.11~ % , A.~.
I°! ~0
.
lot 56
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