HomeMy WebLinkAbout7697-zTOWN OF SOUI3~OLD
BUU,nlNG DEPARTM~qT
Town Clerk's O~ice
Southold, lq. Y.
Certificate Of Occupancy
No. ZG~07 ...... Date ............. June--¥ ...... , 19.7~.
THIS CER~ that the bui]dlng located at .Fleetvood .Roed .......... Street
Map No.xx .......... Block No. xx ....... Lot No. 'xlr ' 'Cu'cohogue "N'.'~ ~ .........
conforms substantially to the Application for Building Permit heretofore ~ed in this office
dated .............. Nzv., · .bo 19.~. pursuant to which Building Permit No. 76c)7z..
dated ............ ,lan...20.., 19.7~., was issued, and conforms to all of the require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
issued is . .Priv~te- one. family' dwe'l.~'ing ......................................
The certificate is issued to . Jtmes. ~-goan. · Mex~e.l.1 ...... ovner~ ................
(owner, lessee or tenant )
of the aforesaid btli]din~.
Suffolk County Department of Health Approval ~y.. 2.$ -- qc~?~., by. ~,~..Vil-le ....
UNDERWRITERS CERTIFICATE No. 1~o2~6.~9 ...... ~a~...~2...~97.~ ............
HOUSE NUMBER ... 790 ....... Street -'F~Le~twoo~t 'Road .......................
...... ......
[ I -Building Inspector /
!
TOWN OF SOUTHOLD
BUILDING' DE PART'%'IENT
TOWN CLERK'S OFFICE
$OUTHOLD, N.. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
7697 'Z
Dote ........................................................ I ........
Permission is hereby granted to:
...h.~ .~. ....... ~¢_21......~!~.,..~.....~..
·.~......~..~.~C....C..~......~.~Z.~
at premises located at ............................................................................................................................
....................................................................... .~.~. ~..~..e..~:.u...~,-. ..................................................
pursuant to oppJicotlon doted ............................. ......... ' ... ....... JVO........ 1 ., and approved by the
Building Inspector.
Fee $- ........................~'
Building Inspector
~ SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Health Services
Reference Number J~-~d ~]?
APPLICATION FOR APPROVAl TO CONSTRUCT
A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY
1. Applicant l~w Bt~. H~s. I~. , Phone
2. Property [-6-cation B/~ ,~l~t~m.t ~.~ 1~,~/~
~ge. ~utcho&~ ToWnship
3. Public Water Company Name
4. Lot size: Width ~ feet
10.
ll.
5o Subdiv.l~-n~6~i
"6. Section
--~. Lot Number
~. Private WeTT
9. Public Water
___~tance to main
Sewage Disposal System:
Ao ~gallon septic tank:
v
Precast ~ ~quivalent Block~
B. Leaching pools:
Number of pools
(For Health Services D~pSz~U~e.)
Precas~~ ~ Block _Special
If private well, fill in the fol-
lowing blanks:
A. Tank capacity ~t gallons
B. Pump G.P.M. $
C. Total well depth. $0
D. Depth to ground wa~er ~
E. Amount of water in well ~
The undersigned CERTIFIES: "Construction of authorized installations will be in accordance
wi~h 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 ~.~c~. ~
Date .~nnua~¥ 7~h, 197~ ~ _ Signed , ~:
=================================================================================
FOR THE DEPARTMENT OF HEALTH SERVICES' USE ONLY. Based on the information presented here-
with, it is the opinion of the Department of Haalth Services that an adequate and satis-
factory Sewage Disposal Syst~ and Water Supply can be installed on this plot.
S-15 i:'?'~"
Rev. 4/1/73 '~ ~