The URL can be used to link to this page

Home My WebLink About7763-z FOltM 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) 7763 Z Permission is hereby granted to: ..T.~h...~.~.~..d.~.e..~....&.....G..e..d...d..e......~..~.d.~e..~.s.~..~.e...A/¢ Leslie & Jane I~ith ..... 2.0...~x.~.~ ~.. 2~. ~.~....~ ............................... ............ ..s.~.~..~.*......H.?..s..~ ............................... to ....B~'I 'l d..33.e~..~.t!-a...£~mt ].~...d,~'l [:ij~g ................................................................................... t lot .~ Bay. have~ @ Southgl4 at premises located a ........................................................................................................................ ........................................... .~.a.z.h. ~.~,e?... ka.~ .e. ......... .S..9..u., .~,~o.~.d.. ........................................................ pursuant to application dated ........................... ~..~.......1.~. ........... , 19.~..~..., and approved by the Building Inspector. Fee $..~.~.Y. ~.~. .......... Building Inspector FORM NO. 6 TOWN OF $OUTHOLD , Building Deportment Town Clerks Office So.~hold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A: This application must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building Inspector with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposol--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, a certificate of Code comp[ionce from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey.of property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent in- formation required to prepare a certificate· C~ Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $$.00 3. Copy of certificate of occupancy $1.00 ~ Date New B~ilding ................ Additio_n~....Z.._.~ ...... .~ ..... OI/d~F,//~ Pre-existing Building ................ Vacant Land .............. Locat,on Of Property ..... ...... :..~Z~.¢~..../~T.~..J~..', ............... ~4 ................................................................... Owner Or Owners Of Property ........... '~' z~...~..~....~.....c~..;.~f.f&.~...~...' " ................................................................... ' .....c'/...~Block No .............House No.~?.~...C? Subdivision .......,~.~..,;/....~..'~..~.. ...................................... ~' ~--- Lot No. Permit No........~.~.:~.. Date Of Permit .................... Applicant ~~~ .......................... - Health Dept. Approval ..... ~.'~.~:..2'.~. .................... bbor ~pt. Approval ................................................ Underwriters Approval ...~.0.~...~ ................. Planning B~rd Approval ........................................ Request For Tempora~ Ce,ificate ........................................ Fin~ Certificate .......................................... Fee Submitted $ .................................... regulations. ....... ............................... Sworn to before me th~s ~ ~ P/~ ................ ~'~'7-] .................. '7 ....... Y' . /O~ /~ ( mp or seal) Nota. Public ~(/~.~, ........ Coun~ ~ ' -~ ~G~RY ~V~LIC, State ~f SUFFOLK COUNTY DEPARTMENT OF HEALTH Health Department Reference ~umber 10. ll. APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY Address ~J~ cO~ L_~_~/~ ~, ~ j~,j~ ~74_ · 6. Section Proper.t~-Location <3~¢)'7-~ ~.~(~ oF~'/~x~v//.~ ~'~; ~-~[~ 7. Lot Number ~j~' ~t 6 }~ ./~,.;~ ~'({ ~,~[c[-r . i 8. Private Well V~llage - ~ ' Township ~a/~/ 9. Public Water Public Water Company Name / Distance to main Lot size: Width~---feet Sewage Disposal System: A. ~ggallon septic tank: Precast ~Equivalent Block B. Leaching pools: Number of pools ~ Precast ~OBlock_ Special If private well, f?~ll in the following blanks: -r~_/~2~z/~-y A, Tank capacity n~gallons C. Total well depth '-[~ D. Depth to ground water E. Amount of water in well Length /'~-~- ~eet (For Health Dept. Use) The undersigned CERTIFIES: "Construction of authorizedinstall~tions will be in accordance with the Suffolk County Department of Health's 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. Date J~ /J-~t ~ [? /~ Signed ~~---- v~,~ .,~~--~ FOR HEALTH DEPARTMENT USE ON.LY. Based on the information presen%ed herewith, it is the Opinion of the Health Department that an adequate and satisfactory Sewage Disposal System and Water Supply can be installed on this plot. /-- S-15 Rev, 4/l/73