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Home My WebLink About7834-z FORI~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N: Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7834 Z Permission is hereby granted to: ~..~...~ ~....c., .o.~ .......................................... ....... b. oz.. ~8.....r~t..2~A ................................... .............. ~.~...P..~.~,~ ....................................... to ..~t~,l.cL.~.e.~i...or~e...~.~...~.~.e.i~.~,~g .................................................................................. a~ premises located at ..~u~¢...~.9.0....,~.a.S,S~,~,..P.O,~-'I~..E/,T'.O~ ........................................................... ............................................. B~o~d~.te r.s.. Roacl ......... C~b~ ............................................. pursuant to application dated ......................~.~,~!, ........ ~.~ ........... 19~.~..., and approved by the Building Inspector. Fee $..'I:.0...~, 2..~. ~.. ........ 'SUFFOLK COUNTY DEPARTMENT OF HEALTH Heal th Department' Reference ~mber , APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant ~tt~/~¢ ~¢~Y~z/_S ~fe',f~ Phone ~/~-¢3z7//(9 Address RT 9~s-~ ~Ox ,~, ~o/~K' ~wYF Property Location ~'. ~,~b~~ '/~m/)~ Township ~'oc~t/my. ~ Length ~ feet/~ lO. ' (For Health Dept. Use) ...... ~Y~',~'~ U ,/~.,/,~Y ' Vil'l'age cz 3. Public Water Company Name 4. Lot size: Width, '-76) feet Sewage Disposal System: allon septic tank: _ i, Equivalent , Block B. Leaching pools: Number of pools Precast Block .... ~pecial ..... ll, If private well, fill in the following blanks: A, Tank capacity z/o~ gallons B, Pump G.P.M, C. Total well depth~//O D. Depth tO ground water E. Amount of water in well 5. Subdiv.~'/~%~Y/x~/~y/- 6. Section 7. Lot Number ~ , 8. Private Well ~¢'~, 9. Public Wate~ ~/~ Distance to ~in.//~ The undersigned CERTIFIES: "Construction of ~uthorized installations 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. FOR HiEALTH DEPARTMENT USE ONLY. Based on the i.nformation presented herewith, it is the opinion of the Health Department that an adequate and satisfactory Sewage Disposal system and ~ter Supply can be installed on this plot. APPROVAL DATE .... ,,~./~)'~ SIGNED ,, ,{~,'~ ,, _ ,~,,, FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E×amined .... ~...../....~.., ] 9.....~.. ^pproved ...... ........ ,92 Peru, ........ Disapproved a/c ~,..~..~..~...~_,.,.,.,~ APPLICATION FOR BUILDING PERMIT Date ...................... INSTRUCTIONS a. This apphcatlon must be completely filled in by typewriter or ~n mk and submitted m triphcate to the Budding Inspector, w 3 sets of plans, accurate plot plan to scale Fee according to schedule b Plot plan showing location of lot and of buddings on premises, relationship to adjoining premises or pubhc streets or areas, a gwlng a detaded description of layout of property must be drawn on d~agram whtch ~s part of th~s apphcat~on c. The work covered by this apphcat~on may not be commenced before ~ssuance of Building Permit d Upon approval of th~s apphcat~on, the Budding Inspector wdl ~ssue a Budding Permit to the applicant Such permit shall be kept the premises available for inspection throughout the work e. No building shall be occupied or used m whole or ~n part for any purpose whatever untd a Certificate of Occupancy shall have b. granted by the Budding Inspector APPLICATION IS HEREBY MADE to the Braiding Department for the ~ssuance of a Budding Permit pursuant to the Budding Z,~ Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the constructlo~ buddfngs, additions or alterations, or for removal or demoht~on, as hereto described The applicant agrees to comply w~th all apphcable la, ordinances, budding code, housing code, and regulations, and to admit authorized inspectors on premises and m buddings for necessary mspectlo~ - ~-4,U.~ _ 'o~ (Address of ap~hcant) / State whetlher applicant is owner, lessee, agent, arch~tec,.t, eg,gin~neral ~ontractor, electrician, plumber or build, ........................ .......- ........................................................... Name of owner of premises ~J~'./~/.~..~..~:~.__...~...~.,....~z~.~.. ....................................................................... .................. - *~ (Name and title of ~rp~)rate officer) 1. Location of land on which proposed work will bedone. Map No.:-~,~,~.. ~.~4,,/,~...~,,,,~.,.. Lot No. c~.,,?l~,. Street and Number ~~....~.~...) ..... ~...~:.~.......~....C~../~ .......................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...................................... ~ ........................................................................................... b. Intended use and occupancy ...~)~....,..~...~,.~.,.~ .................................................................... 3. Nature of work (check which applicable): New Building ....... ~. .... Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... ~.~..~4. /t' 00~, ~ {Description) 4. Estimated Cost ..... --(~'""~ ....... ~ Fee ............... [;~;'l~'~'l~';;~l';;~"~;I;;;~]';'~;;';~;i~'~;;t',;;~i ................................. 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 u~ ..................................... 7. Dimensions of existing structures, if anv: Front .....................Rear ........................... Depth ................................... Height ........................................................... Number of Stories ............................................................................. Dimensions of same structure with alterations or additions: Front .......................... Rear ......................................... Depth ............................................. Height ......................................... Number of Stories ........................................ 8. Dimensions of ~ntire new construction: Front .~ ............... Rear ...~ ..... Depth ...~= ...... ~ ......... 9. Size of lot: Front~--..~ ............................. Rear ........ ~.~ .................... -- Depth .... ~.f~ ............................... 10. Date of Purchase .~.~.~..~.~. ....... Name of Former Owner ..~.....~.,.~~ ........................ 11. Zone or use district in which premims are situated ..................................................................................................... 12. Does propomd construction violate any zoning law, ordinance or regulation: ...~. ............... ~ ........................... Will lot be regraded ~ ........ v ........ Will excess fill be removed from premises: [ ~ Y~~~ 13. 14. Name of Owner of premises .~~...~~ ...... ~..~.~~ ............ ' ¢ ~ ~ , ~Ad~e~ _ (7 , (Phone No.) Name of Archit~t .~~ ..... ,~(....~.~,~.~/...~...~/~,..~ ............ ~..~.~.~:.~¢ ~ ...... ~..~ ~. / (Address) ( hone Name of Contractor .~~.....~.~~ ......................................................................................... ' (Address) (Phone No.) PLOT DIAGRAM Eocate clearly and distinctly all buildings, whether existing or proposed, and indicate all ~t-back dimensions fror proper~ lines. Give street and block number or description according to deed, and show street names and indicate whetk er interior or corner lot. STATE OF NEW YORK, COUNTY OF ........ ~>'.~/..~..'..~..'. ......... .................... ~..~ ......... ~ ...... ~~ ....... be,ng duly sworn, deposes and says that he ,s the apphcant above name ~~.....~.....~~Name of mdivtdud si~,ng con~act) (Contractor, a~nt, co.orate office~ etc ) ~. _ of sa~d owner or owners, and ~s duly authorized to ~rform or have performed the smd work and to make and file th~s application; that statements contained m th~s applicatmn are true to the best of h~s knowledge and behef; and that the work wdl be performed~the man ~t forth in the apphcatmn fded therewith ............ /.~ ............ day of .... ~L ~ z° /. Comm,,s,on Exp,re, March .0, ]¢7~ '--~j .................. / / / / r I I ~ L ~ ¥ FCUNDA. U N ~ d A ~/ T /i _I I