HomeMy WebLinkAbout7725-zFOItM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
No. ~6.7.67 ...... Date ............ N~v... 6 ...... , 197~..
Ti~IlS CERTIFIES that the building located at ... I~/~. N~p~.e..ltoa~ ....... Street
Map No...ZZ ........ Block No.. ~ ...... Lot No..~..Sptt~i~okd,..1~,~, ..........
conforms substantially to the Application for Building Permit heretofore filed in this office
dated .......... ,Tall. ] ...... , 19F. I~. pursuant to which Building Permit No.TF2~7~ ....
dated .......... F.e.b. ..... ~.~.., 19f/.'~½., 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 . .p .l'.t.v.a.~..e..qn.e...f.a.m.~..Zy..d...w.e~..l.~.n.g ......................................
The certificate is issued to F.~.a..r~...R.~.~.o. .....~.fi.~v~.: ...............................
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval Or:t;.. ~t.. ~ 9.7.~.. ~..I~o..V.~.'l],e, .....
UNDERWRITERS CERTIFICATE No, . ~ ~.~.~ ...... Aug... ~ ~...~ ~.~ ............
HOUSE NUMBER ....].~.0 ....... Street . .i,.~p~ .B.o.~d ............................
Building Inspect~
FOEM NO. 2 ~ ·~
BUILDING PERMIT
(THIS PER'MIT MUST BE KEPT .ON THE PI~EMIS£S UNTIL ~ULL
COMPLETION OF THE WORK AUTHoRIZEIJ)
N°. 7725 Z : ~; ~:: 73'
Permission is hereby granted to:
et premises located at ' .''~..Z~r. ....... (.~;,~e,~a~¢~.) ...................................................................
................................................ ,~.,.,~. ,~.~,.....,, ~. o ............................ , .....................................
pursuant to application doted ........................... ~,~,.....~." ...... ....... 19.~.:~.:, and approved by the
Building Inspector.
OUTLETS ?~C~PTACLESI SWITCHES ~N~ ~
22 ~ ~1 r 2~ i 22 i
TH~ NEW ¥O~K ~OARD OF F~RE ' ~ ' '~
, . ' UNDE,,WR~:_RS
' Man~to~ Assoc. ~.d,, e/ de Ma~!e Rd., 1~0' n/o Chestnut~ , Soutno!m~L. I. ~
~a~, fo~r~a to be t,~ c'omphance~t, the,req,tlre ,~e z~s of th is floartt. '?
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
Health Services
Reference Number ~--t~
APPLICATION FOR APPROVAL TO CONSTRUCT
A PRIVATE SEWAGE D~SPOSAL SYSTEM AND A WATER SUPPLY
1. Appl~can~. ~t~"~ ~ .~./'.?,.~ /~Phone ?,/~'~ f, ~,V~ b. ~u~a~v.
Address ,'~,~./ ' ~ ~ ~ , ~/ 6. ectlon
2. Property Location~cx ~L ~ ,'~ ~/ T /7/~"/~' ~ 7. Lot Numb~
%?., ~,./ ~ ~ , ~/ ~' -' B. Private Well
~?~'~'~ ,' <~; ~ ~'~]~' ToWnshi~~' ~"~, / / ~' 9. Public Water
3. Public Wa~r Compa'n~ Name ........... Distance to main
4. Lot s~ze: Width feet Length feet
10.
11.
Sewag~ ~is~Osal System:
A. ~9~2gal~on septic tank:
Precast ~,-Equivalent Block
B. Leaching pools:
Number ef pools~/~,.~
P~ecast (S~B1 ock- Special,
If private well, fill in the fol-
lowing, blanks:
A. Tank capacity ,~'? gallons
B. Pump G.P.M. /. ~, ~2'
C. Total well depth ~ ,, _
Do Depth to ground water
E. Amount of water in well
(For Health Services Dept. Use)
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 e~fect.
Date
FOR THE DEPARTMENT OF HEALTH SERVICES~ USE ONLY. Based on the information presented here-
with, it is the opinion~f the Department of Health Semvices that an adequate and satis-
factory Sewage Disposal Sy~,tem and Water Supply can be installed on this plot.
A PROVAL DATE __ SI NED C-- --,
S-15
Rev. 4/1/73
50.5'
fi-
PINE ROAD
S47~49 '4d'w
ZONED
GRADE
I ~,0.0 0'
. ~YPICAL PRE:CAST
~ L£ACHI NG POOL
n-
4?'
GUARANTEED TO
MAP OF LAND LOCATED'AT
SOUTHOLD
TOWN OF ~OUTHOLD COUNTY OF SUFFOLK
SURVEYED FOR ,
GEORGE H. LUTZ, J~.
[ ..a: 3203,
A
APPROVED AS NOTED
NEl~l'ir"Y BUILDING DEPARTMENT AT
765.2660 9AM TO ~PM FOR REQUIR-
ED I~TION$;
1. ~ BACKR~ IFOUNDA-
TI~ ~ ~ART FR~N~
.9:
,5'-
DATE