The URL can be used to link to this page

Home My WebLink About7990-z FOII~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFICE SOUTHOLD, N. Y. BUILDIING PERMIT (THIS PERMIT MUST BE KEPT CN THE PREMISES UNTIL FULL COMPLETION OF'THE WORK AUTHORIZED) 7990 Z Permission is hereby granted to: · ~...S~,~...Ce~$,t, ru,et, d:on..¢oz~p ................... ...................... Na.t/;l.tuck ................................. to ]~u/ld...r~ew-.-orse..-f. am~.l.y.- ~w~]~.14.z11~ .................................................................................... at premises located at .... J~t.....2.~....JaGkson...La~di.n= ............................................................. ..................................................... W-r..M-~.~-.Hoad ....... Matt 1~i1~&-.-.-1~. yxl-~· ................................... pursuant to application dated ..........................~T~e~ ......9. ......... , 19.~.~..., and approved by the Building Inspector. Fee $ .[J: .'{ .,,. -'~0 ........... Building Inspector FOII~[ NO. 6 TOWN OF SOUTHOLD , Buildir:g Department Town Clerks Office Southot~, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Ir,structions A. This opphcatlon must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building Inspector with the following; for new buildings or new use: l. 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 d~sposol--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwrmters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of cornpleted s~te plan requirements where applicable. B. For existing buildings (prior to April 19§7), Non-conforming uses, or buddings and "pre-existing" land uses: 1. Accurate survey of property showing all property hnes, 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 $,5.00 3 Copy of certificate of occupancy $1.00 .... ................... New Building ................ Addition ................ Old vr Pre-existing Building ................ Vacant Land .............. Location Of Property ~.~.~.~;.~?~..~.~.~.~.~..~i~....v~.~.`~..~?..~D.1?.~}~.~:~.~! .................................. Owner Or Owners Of Property ...... ..~....~.?........C..!.:}..~..~.~.~..~..?..~.~...~,. ...... .f-~ ..~....('.~..: ..................................... Subdivision ...~...~..~..~.~.~..~.!.Y..S;......~..~...~....~..L .~...~ ........ Lot No....~.....~.... Block No ............. House No ........... .................... c Permit No "J ~G ::~ Date Of Permit ........ .', ...... Applicont .................................................................. Health Dept. Approval ..... ...~....~...~...~...~..'!....~.. ............. Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ FinaJ Certificate ......... ~ ........................ Fee Submitted $ .................................... Construction on above described building and permit meets,all applicable codes and regulations. Applicont ........................................... Swor~n to before me t~i,s ~ .... day of ........ Notary Public .... ...~':~/~s'b/~.. County ~t)PF, l)~.~t;~ i)F~P~)~TFhl~II? OF' )4FEALI')4 §~RVICES Health Services Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant ~S'~' £m~-~v~-~ Ore, Phone Address I~'~ ~ ~r~r~.~ ~-.'1. 2. Property Location ~) ~,~ ~ Village ~~¢~- 3. Public Water Compan~ Name. 4. Lot size: Width~ feet 10. Sewage Disposal System: Township Length_~O feet 5. Subdiv.~C~$,~ ~m,~ 6. Section 7. Lot Number 8. Private Well 9. Public Water Distance to main (For Health Services Dept. Use) 11. A. 900-gallon septic tank: Precast ~ Equivalent Block B. Leaching pools: Number of pools ~ Precast ~00%~1 ock Special__ If private well, fill in the fol- lowing blanks: A. Tank capacity. B. Pump G.P.M. C. D. E. lpO ~)~ 9allons Total well depth (~0 Depth to ground water Amount of water in well 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 effect. FOR THE DEPARTMENT OF HEALTH SERVICES~ USE ONLY. Based on the information presented here- with, it is the opinion of the Department of Health Se~y_~rvices that an ade~_q~uate and satis- factory Sewage Disposa/) Syste/m and Water Supply ca~7~iSe/~nstalle~s//plot. $~ " .... :" S-15 Rev. 4/1/73 LAW i 6~ 9 -- '~.~D //// at =MONUMENT // I OF NOS. RE~ER TO MAP OP" dACK$ON$ LANDING TrtE ~O~ATIO~ OF WEL~ ~ND r~qTFO~r~ ' / SHO~9"~ f.E~ELI A~E F~C~I ~ ifLD OBSE~V~TIO~ ~ ~D/O.] FRO~f D~TA ODTAI~ED F~OM~OTHE~ UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION ReViS,ONS YOUNG & YOUNG // ~/~/LY'/8,/97'.~ 400 OSTRANDER AVENUE, RIVERHEAD, ~NEW YORK AUG 21, 1975 ALDEN W. YOUNG HOWARD W YOUNG SURVEY FOR: THOMA~ MEEHAIV ~ SUSAN ME~-HAN LOT NO 25 ' JACKSONS LANDING" ~ SUFFOLK BO., N.Y. ~~~ SGALE. /,~. ~O' DATE* ~U~,/~~~