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Home My WebLink About6477-z ~OP~'f NO. :~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 6~77 Z Permission is hereby granted to: ~ A. ~t~.~.t.l.y-.&...$ot~s ..-~.~ -. ~../-C.... · -~ho~. i 8:Lev~..tano ................... l,/at.~lt~uek ....................................... to .....bt1.,~LlcL.new...one...f. am~.ly...~.~all:~,..g ............................ : ..................................................... at premises located at ...... E/~.....~4e.ak..Lane .......... (F~/S...~a~t~'~,er..~a~:....~s.t,~t ..................... ................................................. .~ ~.....~...r,~.o.~. ................................................................................... pursuant to appiicotlon dated ..................... 'A]p~'~L']: .......... }~' ...... ~., '19..~,~., and approved by the Building Inspector. Fee $...~., ~ ......... FOEM NO. 8 TOWN OF $OUTHOLD Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This app[ication must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspector with the following; for new buildings or new use: 1. Final survey of property with accurate location of all I~uildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewe(age 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, 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 buildings or premises, or other pertinent 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 3. Copy of certificate of occupancy $1.00 $5.00 Date ........ .8./..9. Z'..~ 5 .......................... New Building ....... IJ.~.w ...... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ...... ~"/.~!!r~e?.~.~..~.~..~.~?.~L~.~`~.~.~?..~.~.~r~.~.~Z..~: ................................................ Owner Or Ch~ners Of Property '~ ~icu]ia~o . . . Subdivision ................................................................ Lot No ............. Block No ............. House No ............. PermitNo. 6477~ DateOfPermit.~.~.l.? ...Applicant A: Reill~ and Sons, Ina. Health Dept. Approval .... .8../.~.~..~.~. ......................... Labor Dept. ~pproval ....... ~,.,V., ................................ Underwriters Approva~ .............................................. PIo.n~ng Board Approva~ ~1. r. Request For Temporary Certificate ........................................ Final Certificate .......................................... 5.00 Fee Submitted $ .................................... Construction on above described building and permit meets all a~plicable codes and regulations. Sworn to before me this -- //~'~-"~ ~ Notary Public .................................... County ~.~/~.~,t '~ SUFFOLK COUNTY DEPARTMENT OF H~ALTH H.D. Reference No. APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE S~WAGE DISPOSAL SYSTEM 1. Applicant A./~e/~'A/~ ~O~%;~ ///~ Phone ~6~5. Subdiv. Address ~;~ f~U(~ C/ ~,~,~. Section Property location ~ ~r ~ ~,m~W~. Lot No. ~}r ~,0~. ~/ Private well Public water 3. 4. Public Water Company name ./~/~ ~ Distance to main Lot size: Width /O() feet Length /~ feet i(Enter on center plot below) Sewage Disposal System: A. 900 gallon septic tank: Precast ~Equivalent Block B. Leaching pools: Number ~Precastj~ Block __Special If private well fill Street in blanks below: Tank capacity q~Gals. Pump G.P.M. ~ Total well depth Depth to G.W. Amount of water in well Test Hole Data Feet 0 2 4 6 8 10 12 14 16 18 The undersigned C~ERTIFIES: ~'Construction o~ authorized installations will be in accordance with the Suffolk County Departme]nt of Health's current stand- ards thereto Da t e USE ONLY. ; Owner or Bui~;e~ Based on the infdrmation presented herewith, it FOR HEALTH DEPARTMENT is the opinion of the Health Department, that an adequate and satisfactory Disposal System can be installed on this plot. i -- Date ~/~ /0' ) ~ Signed ~,~~--~/~ ' Sewage S-15 Revised 4/1/72