HomeMy WebLinkAbout7981-zFO.~M NO. ·
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
$outhold, N. Y.
Certificnte Of Occupnncy
THIS CERTIFIES that the building located at Nattke. w$. La~ ............ Street
Map No. No:~.th. W.o. od~lock No ........... Lot No, 5 .... .Qutcko. gue...b. ,~f., .........
confoms substantially to the Application for Building Permit heretofore filed in this office
dated ............ J.ulle.. ~., 19.7~. pursunut to which B-ilding Pemit No. 7.9~.~...
dated ......... .J. tLne .... ~ ...., 197~.., 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.r.i.v..a.t.e..o..n.e..f.a..m.i.l.y...d.w.e.i./..l.ng ....................................
The certificate is issued to . .Wendell .S~;uchel ..... 0~ns~ ........................
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval .Sel~t .. 12 .. 19~.~.. b~..R,..V.i~.l~...
UNDERWRITERS CERTIFICATE No. 112~:~Ii92 ...... Set~t.. 9.... 19.~.~ .............
HOUSE NUMBER .... 3.~I[. ..... Street ... l~t~thmws. Lane .......................
FOF,~I NO. 2
TOWN OF SOUTHOLD
BUILDING DEPAI~TMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDIING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 7981 Z
Permission is hereby granted to:
pursuQnt to Clpplicc~tion doted ........................ ~I%~1e .... ~ ............. , ]9.,i;z~., and opproved by the
Building Inspector.
Fee $...~.6.,.90. ........
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Health Services
~ Reference Number
APPLICATION FOR APPROVAL TO CONSTRUCT
A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY
1. Applicant r
Address , -~ ~ ~.,~ ~ ,~ ~ ~r ,- ~ r~., 6. Section
2. Property LOc~on ,
~V~ltag~-
3. Public Water
4. Lot size: Width ,~. ~. feet Length ,,~ feet
10. Sewage Disposal System:
A. ~O0~-gallon septic
tank:
Precast m- Equivalent Block
B,, Leaching pools:
Number of pools
Precast ~,~ Block .Special__
If private well, fill in the fol-
lowing blanks:
A. Tank capacity. ~ '.~ .gallons
11.
Tq~l well depth
De~h to ground water
Anl~nt of water in well
(For Health Services Dept. Use)
Th~ders~ned CERTIFIES: "Construction of authorized installations will be in accordance
wi~ the S~folk County Department of Health Services current standards thereto. This
ap~icatio~.will be valid for one year from the date of approval indicated below and may
be renewed~'~rf a current local Building Department Permit is in effect.
! ~ ~ ./~ ~/ /
Date .!,,. ~ , Signed ., , f ~ ~,. ..... ,_ ~ _ ..? ~
FOR THE DEPARTMENT OF HEALTH SERVICES' USE ONLY. Based on the information presented here-
with, it is the opinion of the Department of Health Services that an adequate and satis-
factory Sewage Disposal System and Water Supply can be installed on this plot.
APPROVAL DATE ~"/~,//~/~ SIGNED
S-15
Rev. 4/1/73
/~ R = 2§.00' /
I
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ff joq
DATE: ~ ~
NOTIFY BUILDING DEPARTMENT AT
3. FINAL WHEN JOB COMPLE~D