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Home My WebLink About6382-z FOI~M NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH*OLD, iq*. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6382 Z Permission is hereby granted to: Build p~iv~te ~arage ( first ~etlon of a~taehed dwel~In~ & G~o~e) at premises located at ........................................................................... : ........ :~-~...~'~E~. ...................... ~oUthOld N. ~. pursuant to application dated .........................~.?.q~. ....... ~. ....... ¢~, 19.7B., and approved by the Building Inspector. Fee $ SUFFOLK TY DEPARTMENT OF HEALTH HiD. Reference No. ~ APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SiWAGE DISPOSAL SYSTEM Applicant__~.~zzf- p/~.~z - Phone ~-g~-~-.~. Subdiv. Address .,z/z .,~//d~,~,~ <-;~.~2-?-- ~z~ ~'~. ~zP~ 6. Section Property location ~, ~/~/~ ~ ~w-,~ 7. Lot No. 8. Private well Vil~e ~z~az'b Township ~'~z~a~ 9. Public water ~lic~r Company name &J~/~A~v~(3~,r~ ~, Distance to main Lot size: Width /~" feet Length ~ feet (Epter on center plot below) A. ~00/gallon septic tank: Precast Equivalent Block Bp/~ ~ching pools: Humber ~ecast/ f~lock Special If private well fill in blanks below: Tank capably Gals. Amount of water in well Test Hole Data Feet 0 2 4 6 8 10 12 14 16 18 The undersigned CERTIFIES: "Construction of authorized the Suffolk County Departmeht of Health's current stand- 3. 4. 10o installations will be in accordance with ards thereto." Date_ .,~/~ Signed Owner or Builder FOR HEALTH DEPARTMENT USE ONLY.' Based oB the info~mation presented herewith, it Disposal System can be installed the opinion of the ~ealth Department, that an 8dequate and satisfactory Sewage S-15 Revised 4/1/72 on this plot. Signe~-~ FOI~M NO. 1 TOWN OF $OUTgOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ....................................... 19,.,.~., Application No ................................. Approved ........................................ , 19 ........ Pemit No ........................... ~ .......... ~r~gl~ (~ -~ ~3~ ......... ......... (Bui~din~ Inspoctor) ~ .......................... APPLICATION FOR BUILDING PERMIT ',Date /I ~,~ -~' I~., .......... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 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 premises or public streets or areas, and giving a detailed description of layout of property must be drawn on diagram wh(ch is part of this application. ,, c. The work covered by this application may not be commenced before issuance bf Building Permit. d. Upon approval of this application, the Building Inspector will issue a Buildm~ Permit to the applicant. Such permit,shall be kept on 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 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 Zone Ordinance of the Town of Southold, Suffotk County, New York, and other applicable;~ Laws, Ordinances or Regulations, for the constrL/ction of buildings, additions or alterations, or for removal or demolition, as herein described.iThe applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspec1~ors on premises and in buildings for necessary inspections. ' (Signature of applicant, or name, if a corporation) ........... I '. (Address of applicant) //~ I State whether applicant is owaer, lessee, a~enI, architect, encneer, ~en~ral contractor~ electrician, plumber or builder. Name.of owner of premises ~ ~" -'~ ~:~ ~)d/~ If applicant is a corporate, signature of duly authorized officer, ~Name and title of corporate office~} Builder's License No .......................................................... Plumber's License No ......................................................... E ectr can's L cense No ..................................................... Other Trade's License No ................................................... 1. Location of land on which proposed work will be acne. Map No .............................................. Lot No .......... /. ............ / Street and Number // Municipality 2. State existing use and occupancy of premises and intended use and occ~Jpancy of proposed construction: a. Existing use and occupancy ...... ~~ ......... .../~..~..'~,.:.~..! ........................................................................ b. Intended use and occupancy Nature of work (check which applicable): New Building ....... ~ ..........Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work (Description) 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 occut~ancy, specify nature and extent of each type of use ........ ..'2L. ...... ;. ....... 2'; ....... 7. r)imensions 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 ...... Height . . ~ .z././ ......... Number of Stories z2. ............................................. ...... z...(.'..~ ........................... Depth .......... :..q~.~..~ ................................. 9. Size of lot: Front .......d'.~'7.~~ ...................... Rear / ~ ~' / - ' Former Owner ................................. .~... ......................... 10. Date of Purchase ....t./;....'.~. ........... x.: ........ Name of · ' 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 .........~/t~(,, .................... Wdl excess fill be removed from premises: [ ] Yes ~ No 14. Name of Owner of premises ... ~;'~>~-:.~ ~ (Address) (Phone No.) Name of Architect ...........'~/2.~..~ ....... t~.t..¢..~.~.~.~ ....................................................................................................... (Address) (Phone No.) Name of Contractor .....q.P.~'~.~..~..~q~.%~.. ......... .4'~F......~..//.~c¢~....(.i7.'L...ff?.~./.~.~.~..~.--'~.~...t~eZ .r~;...(./...~. ........ (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 wheth- er interior or corner lot. STATE OF NEW YORK, ) COUNTY OF ........... . .J~..%..t~..../~..q. ,~.. !.~ .................. ) ~ ........... ,~*.~.~..~.,'~..F.........4~..../..'.';../.42775 ...................................................... being duly sworn, deposes and says that he is the applicant above named. [ (Nameo£indi~idualsigningcontract) He is the ....... '-- --i (Contractor, age~t, corporate officer, etc, ) of said own~r'or owners, and is duly authorized to perform or have performed the said work and to make and fi~e 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 manne set forth in the application filed therewith. ............ ............... Notary I-UmlC, .x~x~,t~.~~ ~.~{_~ ......... C unty ...................... % ............................... (&gnature o£ applicant)