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Home My WebLink About8011-zTOWN OF $OUT~OLD BUILDING DEPARTmEnT TO~ CLERK'S OFF~CE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne 8011 Z Permission is hereby granted to: .... ~. lf,.~.~....~..,....~ ~.~.~. .............................. ................ ~..o.~...3~.~. .......... ~.t..0..~..e.r.~....z...s.~..~...... et premises located at .....~./..~...~.~..~...~.~..Q]~...?...~.~..~/'.~. ...................... ~1~,~,~,,1~..o..~.,.~..~....~.~....~.~...~.~.~..~..~ ) .......................................................... ..~:.~ ~ .e. ~.~... $ ~.~ ....... ~....~.,. ................................................... pursuant to application dated .......................... ~T.'~-~,~.....~.~ .......... , 19..~'.~., and approved by the Building Inspector. NOTE: Additional adjusted fee due to complete ~eeond floor Fee $.. .~.9 -.80 .......... 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. Appllcant~- ,). ~t,.~,V,r~ Phone~ Address ~ ~c~~ 2. Property Location Village ~t~v~s Township ~_~, ~ ~k 3. Public Water Company Name ~.~_\~k~,x~¥~ C~, . 4. Lot size: Width \~o feet Length' ~u~) feet 5. Subdiv. 6. Section 7. Lot Number-~r~r~-T3 8. Private Well 9. Public Water Distance to main 10. Sewage Disposal System: (For Health Services Dept. Use) A. 900-gallon septic tank: Precast v~//Equivalent Block B. Leaching pools: Number of pools Precast ~ Block ~pecial__ ll. If Im~l~vate well. fill in the fol- :~ low' .~blanks: ~. T'1~f~ capacity ..... gallons m~'(~, l~al well depth ~F~. DL~h to ground water ~ E. A nt 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 APp OV^L DATE S NEB S-15 Rev. 4/1/73 APPLICATION FOR APPROVAL TO CO~S?RUCT PRIVATE SEWAGE DISPOSAL SYSTEMS INSTRUCTIONS: Applications must be submitted in triplicate 1-Means Owner or Builder. Address to which mail should be directed. 2-Means detailed description of property location, together with street name and distance. to nearest intersection of main thoroughfare, also Hamlet/Village and Township. 3-Enter name of Public Water Supply District, together with the distance to their main. 4-Enter Length and Width of Lot under appropriate heading; also enter these dimensions on center plot plan shown on the face of this application. 5-Name of subdivision. 6-Section number. 7-Lot number. 8-Private well -- Enter ~'No" if public water supply is available. Enter "Yes" otherwise. 9-Public water -- Enter "Yes" if public water supply is available. Enter "No" otherwise. PROPOSED SYSTEMS: Answer to Item Number 10, consult the Suffolk County Department of '~ealth Services' Standards for Sewage and Waste Disposal Systems Design of Residential Subsurface Sewage Disposal Facilities. Part I - Residential Subsurface Disposal Systems Covering Cesspools. WELL LOCATION: To locate the well and sewage disposal systems on applicant's lot, the following standards must be observed: Well-lO0 feet minimum distance from the nearest cesspools. Well-25 feet distance from rear and rear sides of property lines when possible. Nell-lO feet distance from front, and front sides of property lines whe@.possible. Well-50 feet minimum below grade for well point. ~ Well-40 feet minimum into ground water for well point. Well-4 feet 6 inches minimum below grade to well head and lateral wate~i~e. CESSPOOL LOCATION: Upon determination of the Sewage and Waste Disposal "typeZo~ systems" requ~', the following standards must be observed for the location of same: ~ 1-Cesspool-5 feet minimum distance from lot lines to exterior of cesspool. - 2-Cesspools exterior must be 100 feet minimum distance from nearest well. 3-Septic tank exterior must be 75 feet from nearest well. ~ 4-Cesspool exterior must be 7 feet minimum distance from nearest water line. 5-Cesspool exterior must be 10 feet from house foundation. 6-Cesspool exterior must be 100 fee~ minimum distance from surface waters, streams, lakes, and bays, etc. 7-Cesspools must be 20 feet minimum distance from large trees. 8-Cesspool exterior to cesspool exterior must be at least 8 feet. 9-Cesspool cover top to grade must be held to minimum of I foot to maximum of 2 feet. lO-Bottom of cesspool to ground water must be held to minimum of 2 feet. Disapproved a/c~~,:...~.~/ .......... APPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS a. This application must be completely filled in by typewriter o¢ 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 9f/applicapt, or 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' ~' --. ~.~.~:...~.. ~.,fZ.~.,~ ...~..~..~../~' '/ .................................................................................... 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 ...... ,.~'...°~....6,,~T..,~. ..................... Other Trade's License No ............................................... .............. ~.. ......... Lot No ................. .~ ...... Location of land on which,proposed work will be done. MapN~ ~(//fl~' ~,' ~rc/~'~)~ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use ond occuponcy ................................................................................................................................ 3, Nature of work (check which applicable): New Building,. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ................................................... 4, EstimQted Cost ~..~ ~00 ~ ~-/~"~'~.~ ~,~,/~%~.(~escription) ........................................................ r~ ........... ~' ~'~;~i~';;"¢'~iT;~"[~' ~¢¢i~;i~ .................. 5. ff dwelling, number of dwelling units ..... ~ ..................... Number of dwelling units on each floor ..... , ...................... If garage, number of cars ..........~.~.~ ................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ .... pth 7. Dimensions of existing structures, if any: Front Rear ................................ De .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ..... ~ ........ · ............... Rear ....~.~,~ .............. Depth .~.?......~ ........ Height ....~.,~ ....... Number of Stories / '/~ .. .................. 9, Size of lot: Front ......... ~ ~./Z~'~ ..................................... Rear ........ /.~ ...........~ , 10, Date of Purchase .... ~.~....Z..~.L~.. ..................... N~me of Former Owner ~.~..~,~,: ................... ~. Zo.e o, .s. d,~,r,~, ,~ *h'ch ~,e~i~ a,~ ~,uo,ed ....Z~~~...~ ............ , ....................................... ~2,Does proposed construction violate any zoning Iow, ordinance or regulation:'- ....... ~, ............................ ~ ....... 13. Will lot be regroded .~:~,~ ~ ~' Will~xcess fill be removed from premise~: (~ ~e~ ~ ( ) No Name of Architect ~ Address .......... ~....,,; .............. Phone No. Nome of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly ~11 buildings, whether existing or proposed, and indicate all set-bock dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner £TATE OF NEWe.~'ORIG, __, ~ c 5 C0~'4T¥ O.F, ..~ ......... .~~~~,..~~...being duly sworn, deposes and says that he is the applicenl (Na~ individ~l signing contrad) above n~med. He is the ............. ~~ ...................................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will Be performed in the manner set fo~h in the application filed therewith. Sworn to b~re me this~- ~ ~ ......... ........ o, .............. ' ' ........... ...... ~ Public St~' L[ ~u ,..No. ' 52-~O~8~'w YO,k ~m EXD~res M~ch ~nC~tY~ ~ TOWN OF SOUTHOLD BUiLDiNG DEPARTMENT TOWN CLERK'S OFFICE Examined ...... Disapproved a/c,~~ ................... :..______ tBuddmg Inspector) APFLICATIOH FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter o¢ in ink and submitted in triplicate to the Building Inspector, with 3 sere of plans, accurate plot plan to scale. Fee according to schedule. b, Plot plan showing location of Iot and of buildings on premises, rebtionship to adjoining premises or public streets o~ 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 o 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 Inspecto'r. 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. .......................... ignotur~/o~.:pp~i.~!:r name, if a corporation) (Address of applicant) State whether applicant is o/~er, lessee, agent, architect, engineer, generaJ contractor, electrician, plumber or builder. Nome of owner of premises .~/.~..~. '.~.~...~ .................................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No .... .~f~_...~..Z~....,--.,,,]:~,. ...................... Bectricion's License No....',/,..,~.':~...~,~-. ....................... Other Trode's License No ............................................... ~"7~' U/L~ '-/: ,~';¢ Location of land on whi, ch propose, d work will b.e done. Mop P-jg~.[~.(..[ .............. ,,~ ............. ~_ot NoZ,4~ .~.. ........ ~ .... Street and Number'~~.-~....~ ............ ]...~..~ ........ ~.¢~,,~L ................................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: e. Exisiting use and occupancy ........ b. Intended use and occupancy 3. lxlatureJJ[,~', (check which applicable): New Building,. ................. Addition .................. Alteration' ...:..,~ ........ Repair .................. Removal .................. Demolition .................... Other Work ................................................. · ~' '~'"" .~,,~_.~ ~.. (Description) o -- ......................... .................................. 4. Estimated Cost ..... ~ ................................................. ret (to ~c~ paid on filing this application) / 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of cars ........... .~.,~.../~.,..~.., ............................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ y F ~ '~ pth 7. D~mens~ons of ex st ng structures, f an rant ............................ Rear........,....................... De .................... ight '--- He ........................ Number of Stories ' Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ....... ~ ....................... Rear.,,..~'....?...: ............. Depth ....~......O~....: .......... Height ....~.....~..~ ....... Number of Stories ....... ./...~../.~.. .................................................................................................... 9. Size of lot: Front ............. ,,~-- --/'""2TT*"~"~ ............................. Rear .......... ./...?=...,~...[ ................... ,,P ~ '~--Dep'~h ... ,.2;~....O..[...~ .............. 10. Dote of Purchase ...... ..C~...f,~..../../../.~..~.~... ................... Name of Former Owner ~....-:~I~-~...~.fR~..: ................. 11. Zone or use district in which premises ore situated ...,/-2~~........./~,"------ ~' ' .................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ...... .~.....~.,.: ...................................... 13. Will lot be regraded ...~: ............. ,~ ~' ,//.Will excess fill be removed from premises:~(;x.) Y~s ,~ ~ ( ) No 14. Nome of Owner of premises '~',,Z~.:,~.:..~ ........... Name of Architect u ~r ,~ .............................................................. Address ................................ Phone No ....................... Name of Contractor "' Address .......... ./f. Phone No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW,~YORI~,~ ~ ~. I~ c co T¥ .qF .... (Name of inc~'vidual signing contract) above named. He is the ......... ~.~ .......................................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove performed the said work and to make and file this application; that all statements contained in this application ore true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to befoze me this Ik -- ! ~ day of .~.~.... , 19../.~ .... - - ~ · ~ ~ ~ ~ ~ (Si~re of applicant) Public, Slate al New No. 52'9509185 Qualified in Sulfolk Counly~a ~m ~pires ~ch 30~ ~ ~ / .~/ T ~/~Po/Z.~ ?-/0/%/ £,,~, a'~',.f. 75 '..~_oZ!tYl ,a./ d Z " 2 6 '.~- //9. ~-5' ' A ~PgZ?, 93 r C ~ I~ L d. J'g ./-/ /'--/ / z9 C'.4.4P Z ,.,/ APPROVED AS NOTED DATE: _ FEE:_ __BY NOTIFY BUILDING DEPARTMENT A' 765-2660 9AM TO 4PM FO,~ REQUIR ED INSPECTI ,ONS: 1. BEFORE BACKFILLING FOUNDA- TION OR START FRAMING 2. BEFORE COVERING PIPELINE 3. FINAL WI-~EN JOB COMFLETED NOT RESPONSII~LE FOR DESIGN OR CON- .,i,STiJUCTJON EI~OR$. 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