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Home My WebLink About7097-z IPOBM NO. 2 TOWN OF SOUTHOLD BUILDIN~. 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? 7097 Z Permission is hereby granted to: at premises located at ..~t...~.~ ..........X~IIIIIS..]~:I~ ............................................. ~ .............................. ................................... ,t~,t, tm,m..~a,..&.,Lma4a ..~..M ............... gltbm~.....l.~X.t ....................... pursuant to application dated ........................~.O~t ....... ~,~ ............ , 19...~., and approved by the BuUding In.~:tor. Fee $.L~3,,.QO ......... ! '- Buildlng~lnspector ( SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Health Services . ..-. Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant Address 2. Property Location Village 3. Public Water Company Name 4. Lot size: Width feet Phone Township Length. feet 5. Subdiv.~ 6. Section 7. Lot Number 8. Private Well 9. Public Water Distance to main 10. Sewage Disposal System: (For Health Services Dept. Use) A. 900Jgallon septic tank: 11. Preca~t ~ Equivalent Block B. Lea'ching pools: Number of pools ~ Precast/oO Block__~pecial__ If private well, fill in the fol- lowing blanks: A. Tank capacity ~l~ gallons B. Pump G.P.M. ~ C. Total well depth. D. Depth to ground water__~_._~j_~ E. Amount of water in well The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health Services' current standards thereto." This application will be valid for one year from the date of approval indicated below and may be renewed if a current local Building Department Permit is in effect. FOR THE DEPARTMENT OF HEALTH SERVICES~ USE ONLY. Based on the information presented here- with, it is the opinion of the Department of Health Services that an adequate and satis- factory Sewage Disposal System and Water Supply can be installed on this plot. APPROVAL DATE ~ SIGNED S-15 Rev. 4/1/73 FOuM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 192/Permit No. ~7..~...~..Z.~ ........ App,cat,o. No. 2. £Z .............. Disapproved a/c .................... ~. ~ ~(Building lnspecto7 APPLICATION FOR BUILDING PERMIT 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. Plot 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 ofproperty must be drawn on the diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building 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, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. ........ ..................................... /~Signature of applicant, ioW'name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..... ,~...~IL.IJ'JgIJJlD,..J[~JL~ ................................................................................................ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No. Electrician's License No. ,~.11~...J41,1111 ...................... Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ..... ~.~....~ ............. Lot No ......~:II ............... Street and Number ..... [~l.-t, JJa~..J~,..~l...~J..~Jll~..~JJ ............ ~J~J.~ll~JJ'""JJ-~'['~ ........................................... Municipality 2. State existing use and occupancy of premises and in;ended use and occupancy of proposed construction: a. Exisiting use and occupancy ......... .~&eJ~Jt, ....................................................................................................... b. Intended use and occupancy ....... J...~:.J~--]..Jr~J ........................................................................... 12. Does proposed construct on v elate any zoning ow, ordinance or regu at on' ..'..: ..~...,lJ~.t.~ ................. 13. Will lot be regraded ~NIIt ................. Will excess fil-/be ret?eyed from premis~ (~ Ye~ (X) No Nome of Architect ..~(I..&.-,ttr~l, ...... ......... ~)ress No;. ~d~iress ~ghone No PLOT DIAGRA~A '~i' ' ' 3. Nature of work (check which applicable): New BUilding ..... 3~lL.r..,iAddition .................. Alteration .................. Repair Remova Demolition ................c~lhe~r Work ................................................ .....~ ................... -h. . ~ (Descr ption) 5. If dwelling, number of dwelling units ........... ~ ..........Nun~er of al, welling\units on each floor ............................ If garage, number of cars ........................................................ =.~, .......... 'i ........................... ............................................ 6. If business, commercial or mixed occupancy, specify nature and e~tent of each type'0f use ............................ 7. Dimensions of existing structures, if any: Front ..................... ~,..L. Rear ................................ Depth .................... Height ................. ' ....... Number of Stories ..............i .......... 'l~ ................. '~ ................................................................... Dimensions of same structure with alterations or adc~itions:iFront ........ ~ ............. '~ ............ Rear ....... ~ .................... Depth ................................ Height............................~umb~r of Stories'!~ ................. : ............ 8. Dimensions of entire new construction: Front......~............ ...... .. Re~r: ...... , ~(~1~.:' ......... · Depth ~..j~: ..... Size of lot: Front .~ ............................................... ~eor .......... ~4~..~ ........... ?-~. ......... De~b. '"'~'~/'"~';'- Date of Purchase .......... ~me of Former ~ner ,~131~..~.J)qllt'. ......................... Zone or use district in which premises are situated .... ~..~.~;[,~ ............ : .......... ~.,.~ ............. ~, .................................. Locate clearly and distinctly a buildings, whether existing oE prol~sed, and indicate all set-back~ dimensions from property lines. Give street and block number or description accprding\to dec~l, and show street .nah"~es and indicate whether interior or corner lot. ~ , '~", ~ 'k / STATE OF N~Y~,_ ~ c c COUN~ OF .~[~ .............. ~o.o ,,,, ........................ .~8..~..~- ........................................ being duly ~w~rn, deposes ond soys thor he is the (Name of i~ividual signing contrac~ ,, ,~ t above named. ~ I: He is the ............................. m~m.~...~.e...~"' ................... (Controctor, agent, corporoto OffiCer, etc.) ' ~ n r or owners ond s dui *uthor xed to per{orm or have'p~r{ormed the soid work ond to rake and file of smd ow e ' Y .... Ii f' this application; that a statemonts contomed m th~s apphcahon are t*~ue to the best of h~s knowledge and be e , and thor tho work will b~ porformod in th~ m*nner ~et {o~h in the opp icot on~ filed th*rowith. .¢ ........... ............................. ~' / ;) ¢ ~3~gnaTur~ot applicant/ Notow pubJic, Slate of New york ~ I ~)eF_.J~azco ~ ~foti~ AJ.A~ FARMINGDALE~ N~'W YORK ]1 J LL ¸ i Il:lo' ' k it' ,I FULTON St!tibET "l i! , I _] I I I NOilFY BUILDING DEPARTMENT FOR BUILDING PERMIT J i'¢ k 'i' · I ~ L