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Home My WebLink About6823-z I~ORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, Nr. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 6823 Z Permission is hereby granted to: ..... .1..t 39 ...~........~.~...~.~. ...................................... ....... .~.v.~.~.e.~0 ................................................... ~o ...~...~?.~..~?.....t.~..z.~..~..v.?.~..z.~ ...... .~..~.r.~.v..~.t..e...,~.?..t.?...,.~.e.~...~.~.. ................ at premises located at R,O,Wo O:f:f N/S Manhanset Ave Green orr N.Y. (a :~ roved b ~ Bd a eals ........................................ ~ .................................. LP. ................. ~ ............ ~1~ ............. ). ............................ pursuant to application dated AUg 27 19.?..~...., and approved by the Building Inspector. Fee $.~..0. ~...0~. ........... Building Inspector SUFFOLK COUNTY DEPARTMENT OF HEALTH Health Department Reference Number ~ mS 0 s/~t7 APPLICATIO, mPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSA[~SY~S~TEM AND A WATER SUPPLY 1. Applicant /~4~7- ~//2/~ .Phone 72 ?'/ ~ ~ 5. Subdiv. Address //~9 ~, /~'//~, ~ /~'~2, ~,,~6. Section 2. Property Location ~ /~¢,,~/zJ"~ z~/~ 7. Lot Number 8. Private Well Village ~,~ ,~ ,, ,~, ~ ~Township ~i' ~ ~ . [ ~ 9. Public Water / 3. Public Water Company Name ~/~ ~ ~/- ~,/~'~;,~ Q,Distance to ~in ~' 4. Lot size: Width / m~feet Length, 2 ~ .; feet 10. Sewag~sposal System: (For Health Dept. Use) A. ~O0~allon septic tank: V~ Precast~ ~Equivalent Block '~ .... B. Leaching pools: ~¢1~ ~ t ~ Nu~er of pools ~ ~ Precast/~Block ~pecial ~ ~ ~' If private well, fill in the ~ ~ ~lO~ gallons D.~Depth to ground water ~ E.~ount of water in well //'.?' ~ ~ ?.~ ~ ' ~>. ]- ~nder~gned CERTIFIES: "Construction of authorized installations will be in accordance w~h the ~ffolk County Department of Health's current standards thereto. This application w~l be v~id for one year from the date of approval indicated below and ~y be renewed if a current local Building Department Pemit is in effect. ll. fol 1 owing bl an ks: A. Tan k/s~ ap.¥~i~y~ % ~. C~ T~)tal well depth _-_-- FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the opinion of the Health Department that an adequate and satisfactory Sewage Disposal System and Water Supply can be installed on this plot. APPROVAL DATE r-~ .~ /~///)~?//~ ~ SIGNED ~ ~ S-15 Rev. 4/1/73 TOWN OF SOUT,OLD BUILDING DEPARTMENT ~'"'~,' ......... , · ,..i, ................................... Di~r~ a/c .............................................................. ..................................................... : ........ APPLICATION~FO. BUILDIN~ PE~IT INSTRUCTIONS :~' completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with~.z This application must be 3 sets of plans, accurate plot plan to scale. Fee according to schedule..x- b. Plot plan 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 drawn on diagram which is pert 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 ~nspection thl~oughout the work. e. No building shall be occ~uPied or used in whole or in pert for any purpose whatever until a Certificate of Occupancy 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 Zor~ Ordinance of the Town of Southold, Suffo/k Ceunty, 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, and to admit authorized inspectors on premises and [p buildings for necessary inspections, (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant 'is owner, lessee, agent, amhitect~ engineer, general contractor, electrician, plumber or builder~ Name of owner of premises .... ~~......~... ~~i ..................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1.StreetL°cati°nand°fNumberland on..~..~~.~...~which proposecJ work will be done. M, ap No.: .................... Lot No. 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....4'~ ............................................................................................................. b. Intended use and occupancy ~. ~..~~ ~:~m ~.~ & ;~. Nature of work (check which applicable): New Building ....................... Aeo ...... t on .................................... Alteration Repair ......................... Removal ......................... Demolition .................. Other WOrk (Description) o ...................... : ................................. 4. Estimated Cost ..~.....~/..~. ............................. Fee (to be paid on filing this applicationt 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 occ. up,ancy, specify nature and extent of each type of usa ..................................... 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 of Stories ........................................ 8. Dimensions of entire new construction: Front ..... ~,~...~.. .......... Rear ......... .~...'~.. .......... Depth .....~.,.~... ................ / Height ............. ~/. ........................... Number of Stories ......................................................................................... e. j~ j~f r .,.~./,,'s~-'- (...~ De th ......... ,~..~.,,t'..'~.. ........................... 9. Size of lot: Front .................................... Rea ............................... P Height .................................................... Number of Stories ...................................................................................... 10. Date of Purchasa ..................................... Name of Former Owner ......... 11. Zone or use district in which premises are situated ........... 12. Does proposad construction violate any zoning law. ordinance or regulation: ......... ~ ..................................... 13. Will lot be regraded .............................. Will excess fillJ~e removed from ~eznises: [ ] Yes [~ No 14. Name of Owner of premisas ..../t~'..~......~....~.~~i....~"'i~'~n'~) Name of Architect ..................................................................................................................................................... ~ .,,~ddress) (Phone No.) Name of Contractor ,.J ............................... ~r,' m~one No.)'¢~' (Address) PLOT DIAGRAM Locate clearly a~d distinctly all buildings, whether existing or proposad, and indicate all sat-back dimensions 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 YORK, ~ / ) ~ COUNTY OF .................... ~ ~.~/~ .......... ) . . . . . ., (Name of individ~l si~ing con.act) duly sworn, deposes and says ~hat he is the applicant above named. (Contractor, affent, corporate of]Tcer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make 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 forth in the application filed therewith. .................... ...... ............................ ..... ...................... Notary Public ............................................................. County °' ~? (Signature o/applicant) r ~ ~I~tLL ROAD .b / / / / NOTE DATUM = 0.0 PtiG~,I WA.:.~-, ~A~K OF GULL · TEST HOLE' ~i.73° 55" lO"E, "5 ~b RAYNOR DRIVEWAY ~'.,.~'r~r S T 55.60 TLfTI.4II,.L / PRIVATE / ROAD / / MA:'? OF PROPI~RTY SURV EYE. D FOR. · MARY L. RAYNOR ° AND · ~A~. OLD SITUATE RAYNOR GREENPORT TOWN OW SOU~NOJ..D,N ¥. SCA L.E. ~) =l~.ON P~PE b,1 = M 0NuM r-'N.T ~.=_ WELL AI~EA = 4.5,ooo*- SQ. FT. · NOTE DATUM" 0,0 IV~A~K OF GULL POND TUT ON GUARANTEES AI~E NOI' TJb'~NSF[.~ LICENSED LAND SU~N':='~' ~'- GEEE~PORT. NEW YOE~: Iii t1'- o AP£1~OVEt~ AP gi ED LA,u F~E' hlO I ;Fy BUlLr 7(5-2660 97,, 2. CUVE~I~ pip: LINE .............. ~" ~"~"~ ~ COMPLETED I~OT RESPONSIBLE F~R DESIGN OR CON- STRUCTION ERRORS , '.~,4 ,'~q ~.. [ . :'. /~ U,' ~ 3 ', 3