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Home My WebLink About6432-z FOI~M NO. 2 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? 6432 Z Permission is hereby granted to: ~.e..~.r. ~p....:~.~..r. .............................................. ....... ~.~.~...~,,o.~.~ .............................................. ~attltuck N,Y, to Build new one fa. mi!y., dwellin~ at premises located at ...... ..~../...~...?.~..~.~,,~..~.?.....~...0.~.~.......~..~.~...). .............................................................. Mattttuek N ,~, pursuant to application dated ............................. ~.~.. ......... ~..~....,, 19...~.3., and approved by the Building Inspector. Fee $....~.?.?.~....~. ......... SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D. Reference No. ~O~ APPLICATION FOR APPROVA~TO CONSTRUCT m PRIVATE SEWAGE DISPOSAL SYSTEM 1. Applicant~ i'~. ~ ,/$~v~13zZfrc~ Phone~)(~775. Subdiv. Address frli ~TM~ ~W ~ ~TT. ~W:*~ ~6. Section 2. PropErty locatio~. ~ 7. Lot No. ~iaRe f~'~- Tgwnship~,.~Z~F~f 9. Public water f)'~ 3. Public Water Company name f ~g'~ , Distance to main._ - 4. Lot size: Width~f~e~~f feet (Enter on center plot below) 10. Sewage Disposal System~~ ~ ~ ~ / A, 900 gallon septic tank: Precast~ Equivalent Block__ B. Leaching pools: Number_~ Precast Block Special If private well fill in blanks below: Tank capacity~ls. Pump G.P.M. ~ Total well depth,~ ~ Depth to G.W. ~1 ~ Amount of wa t, er in well ~' Test Hole Data Feet 0 2 4 6 8 10 12 14 16 18 The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health's current stand- ards thereto,~ Date the information presented herewith, it FOR HEALTH DEPARTMENT USE ONLY.' Based is the opinion of the ~Health Department, that an ~dequate and satisfactory Disposal System can be installed on this plot.~.---,,~j)/j~/Z/I~ "~ Date //~ ~"- '~,,~ Signed/~ ~ ~- ' Sewage S-15 Revised 4/1/72 TOWN OF $OUTHOLD : Building Del~tment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in triplicate to the Building Inspector with the following; for new buildings or new use: h Final survey of property with accurate location of all ~uildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and seweiage disposal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, s;treets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent in- formation required to prepare a certificate. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use' 3. Copy of certificate of occupancy $1.00 $5.00 Oote .... ~:,,l~~:......~.../..,f~ New Building ............ Old or Pre-exist ng Bud ng ........... Vacant Lan~ ........... >....; ........... ........ , : , t-ocation Ut ~roperry ............................................... ¢, ....... ~ ............. ........... 5' ........................ uwner ~r ~ners ut ~rope~y Subdivision ........ ~ .......................................... Lot No ...~ ..... Block No ............House No ............. .... ,.o .................. ¢. .... ............................................................. ~eath ~ep~. ~pprova ............................................ ba pt. pp ................ ; ........................... Un~.r~r"..~ App~o~ ~!~.9.~..! ............ ~.~..2~."~..~.~ .o.;d App.o~.~ .~.Z~.'. ....................... Request For ~emporary Ce~ificate ........................................ Final Certificate ........ ~ ............................ ,. S.b~t~.d $ .~.::: ................... Sworn to before me/tl~is ........... . .~. ~ay of ...L&~......./.~..~. Notary Public .................................... County ._.?.'cable codes and regulations. (stamp or seal) ~/~,. ~,~_~ F~,i~ NO. ~ TOWN OF $OUTHOLD Building DePa~menf Town Glerks Office Southold, N. ¥. 11971 APPLIGATION FOR CERTIFICATE OF O(:GUPANCY instructions A. This application must be filled in typewriter OR ink, and sul~mitted in triplicate to the Building Inspector with the following; for new buildings or new use: i. Final survey of property with accurate location of al) buildings, property lines, streets, and unusual natural or topographic features. ~ 2. Final approval of Health Dept. of water supply and seweri~ge disposal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Re§idences and similar buildings and installations, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board opprovat of comp[eted site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, s{reets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent in- formation required to prepare <~ certificate. C. Fees: 1. Certificate of occupancy $5,00 : 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Date ........................... New Building ....... ..../.... ..... Old or Pre-existing Building ...~ ............. ' ........... Vacant L,,and,. ...... .;.; ......... r ....... ...... Loc~tion ~t vroperty ............................................ Owner Or ~ners Of Property ............................. ' .............................................. ~ .......................................... Su~ivision ............................................ Lot No .....~.,.. Block No ............. House No ............. Permit No .....~ ........ d.. ~ate ~t ~erm t ..X,.%,L,.,~.i..,.~pp~cQnt .... ~ ............................................................. ................................. ?..,or ........................... ................ Underwriters Approvol ................................... ~..Pbnnmg Board Approvel ........................................ Request ~or Tempora~ Ce~ificote ........................................ Finel :Certificote $ ................... Construction on above described building and permi~ meets ell e~pliceble c~es end reguletions. Applicant ......................................................................................................... Sworn to before me this ................ day of ............................................ (stamp or seal) Notary Public .................................... County