HomeMy WebLinkAbout6485-zFORM NO. 4
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
Town Clerk's Ot~ice
Southold~ N. Y.
Certificate Of Occupancy
No.
Date
19.
~9820 ...... ............. .... ~'- .....,
THIS CERTIFIES that the building located at ~.~ .~.1,1~, .DFive ....... Street
Map No.so~lth. old. shB, lock No ........... Lot No.. T~'" Gl'ee~apo~s~- ~.Y...(.Sou.$hold
conforms substantially to the Application for Building Permit heretofore filed in this oP~e
dated ......... April .... 3", 19. '73 pursuant to which Building Permit No. 6~+8.%Z.
dated ..... Aprlt'' '~6 ....... , 19.73., was issued, a~d conforms to all of the require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
issued is .Priva%e. (:me' £~mily dwettil%~ .......................................
The certificate is issued to . 'l~urr~y' We~mall ........ :Owner .......................
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval - ·. Ma.l~ - ] %,..] 9~}+ ..................
UNDERWRITERS CERTIFICATE No .... }I..$~??~.$... gala..]h.. ].9~1+ .............
HOUSE NUMBER .... ] ~ ~O ..... Street .. ~ue- ~ar~it~ -gri. ve ...................
~[E.r .Fetmdation · fo~. a~.taehe~ .gara. ge - Xnst~t.te~ ~..~arag~ · t~ .be. c~m~leted
Building ~n~pec~or ~
FOI~I NO. ~
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 T~HE WORK AUTHORIZED)
Date ...................... Ap~.il ....... 1.6 ......... ,
Permission is hereby granted to:
........ · B~c...T......?...Lak. o...D~ ................... : ............
..... ,.S~e lt~r Is,land
to .~t~l~..mew...ome...~am~.l.y..~wel.l.i~ ......... : ..........................................................................
et premises located at · .~o~¢-*.~ .......~*~A'$h*~d..~hc~lo~S .................................................................
....................................... Bl~e..~e.~.Zln..~ ........... G~.ee~'.~ ....................................................
pursuant to application dated ............................. ~p~7~.~'""~ ........ ~ 19~...., and approved by the
Building Inspector.
Fee $..4.~.,r~0 .......
plUS $ ~,00 fOr
April 12, 1974
Building Department
Southotd Township
Southold, New York
Att: Mr. Terry:
This is to acknowlege mY advise to you
that the stairway railings in my home at 1150 Blue
Marlin Drive, have been completely ~nstalled and that
materials have beene,ordered to complete the facing on
the fireplace.
We anticipate and expe~t that the fireplace
facing will be complete by May 15, 1974.
~W/pm
Yours truly,
Murray~ Wfitman
SUFFOLK COUNTY DEPARTMENT OF HEALTH
H.D. Reference No.
APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SiEWAGE DISPOSAL SYSTEM
1. Applicant ~,,,~r ~mm~ Phone io. Subdiv. Sa~lthald
Address m~-~-~ ~-~+~ ~:N_~. ~6. Section ~m~ ~
2. Property'f~c~t-{o~-~l~-~ik&"D~{~ ..... !7. Lot No. ' I~ -
~8. Private well ~
Village Rm~M~d Township - ~ ~ 19. Public water
3o Public W~mpany name~r~g~w~£~-~~z~Distance~ ~-~--~ m~ to main ~'
4. Lot size: Width ~ feet Length ~ feet i(Enter on center plot below)
10. Sewage Disposal System:
A. 900 gallon septic tank: Precast ~ Equivalent Block
B. Leaching pools: Number ~ Precas~ X Block Special
be in accordance with the
ards thereto."
If private well fill
in blanks below:
Tank capacity 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 CERTIFIES: "Constr%ction of author'ized
Suffolk County Departmgnt of H~ealth's current stand-
FOR HEALTH DEPARTMENT USE ONLY.
installations will
Signed ~ ~~ ~,~
Based on the infdrmation presented herewith,
it
Disposal
the opinion of the Health Department, that anladequate and satisfactory Sewage
System can be installed on th~s plot.
~--__~ Signed
Date
S-15
Revised 4/1/72
EXCAVA110N INSPECImN REQUIRED
1
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011512
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