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Home My WebLink About6467-zFOR1Vf NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy Ho. Z~6.~kq ...... Date .bto~ .....8 ......., 19. ?3. THIS CERTIFIES that the building located at 'B~.~ch' D~';t~'e .............. Street Map No. aaX ......... Block No. x~ ....... Lot No. Xx~...Laud..e~.. · ~oX, ............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... A~pI':I.Z.. '5', 19. '~3 pursuant to which Building Permit No. 6h6?Z.. dated .......... tkpa~il...9..., 19 7.3., wa.s issued, and conforms to all o£ the require- ments of the applicable provisions of the law. The occupancy for ~vhich this certificate is issued is . P. rivate, one. family..dwelling ...................................... The certificate is issued to . l~lwalycl .Kla.tt ..... 0whale ............................. (Owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .Oet.. 21~..~.9.~.3.. lay. R.,..Villa .... UNDERWRITERS CERTIFICATE No.. 2I.'1214,000 .... ]0~;..~..~ 9~ ................ HOUSE NUMBER. (~05 ......... Street..l~.r,h. D~,~e ........................... ........ ............ Building Inspecfr TOWN OF SOUTHOLD Building Department Town Clerks Office Southold, iq. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and sctbmitted in DUPLICATE to the Building Inspector with the following; for new buildings or new ~ise: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage dispasal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Ut~derwriters. 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, streets, 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 buildi~gs or premises, or other pertinent in- formation required to prepare a 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 DaCe ............ New Building ................ Addition ................ Ol~d or Pre-existi? Building ................ Vacant Land .............. Location Of Property ...~j:.~..C/~,~..~..,~.~..~ ........... .~..~ ............................................... Owner Or Owners Of Property ~..-~..:.....~_~.~.../~.~.~./.._~~ ............................................. Subdivision ................................................................ Lot No ......... ¢... Block No ............. House No ............. Permit No,. ~,~,~.:~...~. Date Of Permit',~.~..4~...~.,...Applicant .~.~..~....~..~.....~...~.. ~.~ ............. Health Dept. Approval ...... ,~.....~,'~.~.~.?.':~...~.. ............ Labor Dept. /~pproval ................................................ Underwriters Approval ..... .~,~'J,:Z~'~.CZ.~... ....... Planning Board Approval .._,_.:~, ............................. Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ ....~..~.~.-..~?./~-.).. ................. Construction on above described building and permit meets all gpplicable codes end regulations. ....... Sworn to before me this /,~/~q/7 ~ day of ~: ~ f ?~ (stamp or seal) ~ ~ Notary Public .................................... County SUFFOLK COUNTY DEPARTMENT OF HEALTH EASTERN DISTRICT, RIVERHEAD ~ N. Y. APPLICATION FOR APPRC~,AL TO CONSTRUCT PRIV,ATE SEWAGE DISPOSAL SYSTEMS D ' Approval to constrUct said sys'tems is requested,pertinent data herewith: ate 1-Applicant ,,V~7 ~.~,/ /~(g~'~'~. . Phone ~ '~/'-~j/)6-Sub .div 2-Dotailed-pr-operty .~b6~tlonzO~/~,~,/~$ ~:~J ~Z~//~2d;Z8-Lot No. Hamlet ~A//y~/~_.~ ' T0~ ,~~ '. 9-Private well? H.D.Reference No.P~-3~7.~ 3-Public water suppl~ name , , D~stanee to nearest main .' , 4-Lot S~ze: Width~/~ ft. Len~tb~-n-~ ft. (also enter On ,~enter plot plan below.) S-Dwelling: Single Family ~F/; Two ,Family? ~_/~ellar? ~,Slab? / ~ Crawl Space? ~_~ lO-Proposed system: Septic {ank ~//Precast /%Z/Cesspools · /Shallow pools / /Other / 11-Septic tank insid, e dimensions: ~lume~fJ Gals.Lengthj, ft. TJilth~, .fl~cLsi.%uid~ndesP~h ft. 12-Precast sections. /~Number .~quare Ft. Cesspools, Bloc s ze . ,,. ,ins. PLOT PLAN .G rode G W.L. Capacity~Gals. G.P.M. ~ --J 'l'es~ ~ le Data ~eet 2 6 10 3/ 12 ~6 18 The Undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Health Departments' current Standards, Bulletins, and amendments thereto, covering Private Sewage Disposal System~". Date Signed ~-t~ ~g Owner or iBuilder FOR HEALTH DEPARTMENT USE ONLy. Based on the information ~resented herewith, it is the opinion of the Health Department, that an adequate and satisfactory Sewage Disposal System can be installed on this Plot. Date (/(74'~.} (10/65 Revis.) S-15 ~ Signed