HomeMy WebLinkAbout7762-zFO~M NO. 4
TOWN OF S0 T LO
Town Clelk's
tout~olJ, N. ¥.
Certificate Of Occupancy
No.Z.6.~.93 ....... Date ............. .J..u~.e...2.3 ..... , 19..~.~
THIS CERTIFIES that the building located at . .G:~eel~'~11..~ .Hom~s~e~1. Street
Map No.~a~r~..8.h Block No ........... Lot No, .~.h:.{~ ...... ~.~r~p.o~.~....N...Y. ? .....
conforms substantially to the Application for Building Permit heretofore filed in this office
dated .......... .1,~a~-...20..., 19.7~. pursuant to which Building Permit No..7.76~Z.
dated ..............l~a~,-. ~O, 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 .. '.e.r.~.v..a.~p..o..ne. f.a..m.~.l.y...cl.w.e. 1..~.~ .n.g ......................................
The certificate is issued to . .H..oh~ ..J,. ~.a3.1.~th ....... .0~.~.~. ........................
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of HeaIth Approval .. ~ur~e. ~..1.97.~...by. R,. Villa .....
UNDERWRITERS CERTIFICATE No. ~2~.3.2.~.~ .... ~..u,~. 9..~.8....1.~. ................
HOUSE NUMBER ..... : .8.0. ..... Street .. ~.~.e.e..~.~.~.~..~..Rd.., ........................
Building Inspector '~ ........
I~OR~ NO. ~
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
/
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETI~NI OF THE WORK AUTHORIZED)
N? 7762
Z
Permission is hereby granted to:
Oru]alZl..C ~ ~.~. ~,...A/.C...*.Je~...¥,~.3..~ St~ .....
....... 3 ~56..... ~;...~,..~ 2 ............................................
....................... ~.~'.~r~. ........................... : ...........
to I~!! ~'1: &..~W...one.. £.a mt ~Ly... d.w~.1 .l~.n~ ......................................................................................
at premises Iocoted at .3~ot,..#...~,h~...,..~a/s~e~a...fili~c~,e~-*.:~ee*-.¥. .............................................
................................... O~'e e~..~i~.3~(..~a..&. ~4 eaee ~-ad.. 44a¥- ......... Ca, e~nt~ ~c ........................
pursuant to application dated .................. Yl~.C.~....*~O ............... , 19~...., and approved by the
Building Inspector.
Fee .........
;?
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
Health Services
Reference Number
3.
4.
lO.
APPLICATION FOR APPROVAL TO CONSTRUCT
~,.~A ]~RIVAT, E SEWAGE DISPOSAL SYSTEM ANDA WATER SUPPLY
. I ~ ~ Z~,~ ~,
. ,. :,,., ,
Applicant/,., ~"~. :~:.-.,, .,,~ ~' 2" ,,'~/.~n¢~.,...~: .,~1 ~/, ~:~ ~. Suo~v.
Address ¢/~,,'~i¢ ~ C~'~ /41~',-' ~,¢~6- Section'~
~t~o~'~:~ep/' ~, ~ 7. Lot Number
,_ ,~,, , ...... , .~ /,,f 8. Private Well
Village ' Township 9, Public Water.,
Public Water Comp, a~, Name , .,:, '/, ,_,, , Distance, to main
Lot size: Width feet Length feet
Sewag,e. Disposal System:
A. '900-gallon septic tank:
(For Health Services DeEt. Us_9_e)
Precast Equivalent Block
B. Leaching pools:
Number~,~'pools
Precast Block ~pecial
11o
If private well, fill in the fol-
lowing blanks:
A. Tank capacity~gallons
B. Pump G.P.M. # ~
C. Total well depth
D. Depth to ground water
E. Amount of water in ~ell
The undersigned CERTIFIES: "Construction of authorized installations will be in accordance
with the Suffolk County Department of Heal th 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,leffect.
Date Signed
FOR THE DEPARTMENT OF HEALTH SERVICES~ USE ONLY.. Based' on the information presented here-
with, it is the oPinion of the Department"'O~' Health Services that an adequate and satis-
factory Sewage Disposal System and Water Supply can be ~nstalled on this plot.
S-15
Rev. 4/1/73
~ddffJon tb thi~ ~urvey is o vioJafion o~ ~cfion ~09 of the New Yor~ ~a~o Educotlon Low.
Agency and Lending institution listed hereon, a~d to the A~ignees of the Lending Institutiom
0
~U~OL~I~ 00U~-~TH DEPAR2M~N~
./r.O, ~ /.
ulo/f/v /~£ /5/4
~ ~ ~-~-/v~o,~ 7; .Ag. W.