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Home My WebLink About9839-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. UPDATED Certificate Of Occupancy No..Z.l.q..4 fl.2. ......... Date ...... J...a.n.u.a.r. ¥..2.4. ............... 198..3. THIS CERTIFIES that the building ................................................ Location of I'~operty . 5. .2 ~ ............... ~.e.s.t...CT.e.e.k. . by.e.n.u. 9 .......... .C.u.t. q139g.u.q... - House No. Street Hamlet County Tax Map No. 1000 Section . . 1 03 ....... Block . .1 $ ........... Lot . .0 .15 ............ Subdivision ...... .X. ....................... Filed Map No..X. ...... Lot No .... X. ......... R~equir?ment,s, for ark UpdatedoCe~r.t,i, ficate of Oc~cupg.nqy, ,,appl~i. ca.tioD conlorms suestantiaiiy to the A-Fp~im-tfo,n'-mr-tmi'laN'nE-the~-h'ereto'rore-fimrt=irr~fl~m~ Updated C.O. r..eg.e.J:¥9.d' .D.c.g.,..2. !.., 19 .8. 2. pursuant to which B~m~ ~fm'lt No...z .13.44 .2 ............. dated ... g.&n.~3g.ry..2..4 ............. 19.8.3., was issned, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... · ~. hr. i7.a.t.e..o~.e.-. ~..ara), k.y..d.w.e .1 J&.n.g, ~ .......................................... The certificate is issued to . . .A.ug.u.S.T~:H.~..'7:..s...~.~9.~.~..I.~h .J..-..G.I.r,. b.~.~. ................ (owner, lessee er-tenant) of the aforesaid building. Suffolk County Department of Health Approval .8.-.S..O.-y. 1. ~. 39./.3.0/.7.8. ~..a.o.b.t. :. A-...Vkl. 1..a.. UNDERWRITERS CERTIFICATE NO ........ N..4 ~ ~B.56 ,. D. ec ,..1.8,. J.9.7. 8 .............. Rev, 1/81 Building Inspector *This is an updated C.O.: B.P. 9839Z issued 7/14/78--C.O. Z9371 issued 1/4/79 for new dwelling B.P. 10186Z issued 4/23/79--C.O. Z9748 issued (add.) B.P. 11199Z issued 6/22/81--ok (fenCe) B.P. 11673Z issued 5/21/82--C.O. Zl1158 issued 8/24/82 (roof over deck & outdoor shower enclosure). TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Offiee $outhold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at .52~. West- C~,eek..Ave ...... Map No ............. Block No ........... Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... July....~%. ........ , 19. ?.~ pursuant to which Building Permit No. dated .... Jul.y. ·..~7. ........., 19..7.8, 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 ..... Pr&vats .One. F.~i~hy. ~e.~L~ng. w&th. I~eck. Addi~&on ............ The certificate is issued to ....... Aug~st~,~ .0',..&..~.e.o.rg%.n..a..J.,..G..~.~.~.n. .......... ( owner, ~ ) of the aforesaid building. Suffolk County Department of Health Approval ........ October..30,..'~97~..~:~.-~.0-7~ UNDERWRITERS CERTIFICATE No ...... I~/~/4~6 .............................. HOUSE NUMBER .... ~2~. ...... Street ........ .~.e.s..~..C.r.e..e.k..A.¥.e ................. .............................................. ?., ................ Building Inspector County Tax Number 1000-10~-13-15 FOEN[ NO. ~ TOWN OF SOUTHOLD BUILDING 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) N? 9839 Z Permission is hereby granted to: ...... ~ua~-,,e .O:...&..(3e~'s~l;na.J~.....~,.3..:Len ' · 'p~Jrsu~nt to epplicaton Bui!ding Inspector. ...................... ............................. .Cutolm~e~ ..Ne~:.~r~Z~..., ......................................................... Jated ......... t~..~''' ....... '~'"'??~r,'?,"*~,"' 19,~..~... and app~'oved by the 10o0-1o~-1~..15 H,8,---8-SO-71 DES~ AP[ROVAL TO F LL FROM ABOVE ,pREMiSES, BY REGRADING LOT DR VEWAy C ' C~L~ TO~(N OF SOUTHOI.D Building Deportment Town Clerks Office $outhold, N. ¥. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in triplicate 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 disposal--(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 compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. Far existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey aT 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 3, Copy of certificate of occupancy $1.00 $5.00 Date .......... New Building ...........~ ....... Old or Pre-existing Building ................ .~. .......... Vacant Land ..... ~ .................... Location Of Property ....... ..~..~..~....~......~....~'..~.Z~.....c~...~..,~....~...~......~. ..v...~.~. .................................................................... Owner Or Owners Of Property ~/~.U..G.~.~.....T`../..~...~....3~..~.'~....~..~..~.~..~...~.~!~..~...~..~..~....~../~ .............................. Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No....~..~...~...~....Z. Date Of Permit ...~...~....J. ZZ.'7.~ppllcant ..P~...f..~.~..Y../..~'.~'~...~-..~....~-.~..~...~/...~.~...d.~...~./..// Health Dept. Approval ....O.,.~.."~....~..~...../~.'~..~.. ............ Labor Dept. Approval ................................................ Underwriters Approval .... .~...G'.~..~..../-.G...../..'~..~..~.. ........... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ ...~.~ ..................... Construction on above described building and p~ermit meets all applicable codes and regulations. Sworn to before me this ................ o, ............................................ o, Notary Public .................................... County ~- L) ~ FORM NO. 8 TOWN OF SOUTHOLD Buiiding Department Town Hall SouthoM, N.Y. ", .... ~,, ~ APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted in duplicate to the Building lnspec- tot with the following; for new buildings or new usa: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or tooograohic features. 2. Final approval of Health Dept. of water supply and sewerage disposal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buiiding~ and installa- t/OhS, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning 8card approval of completed site plan requirements where applicable. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty 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 informa- tion required to prepare a certificate. '/ 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 ............. Old or Pre-existing Building(Z) .,_..X__ -~ =/Vacant Land '. ........... Location of Proper y .... ........... . . .r,f. ..... Hou~ No, Street Ham/et Owner or Owners of Property ~OdS~¢ County T~x Map No..lO00 Section ...... ~ff.~ .... Block .... ~.~ ...... Lot .... ~¢~ ...... Subdivision ................................. Filed Map'No.. Health Dept, Approval ........................ Labor Dept. Approval Unde~riters Approval ........................ Planning Board Approval .................. Request for Temporary Certificate ..................... Final Cerdfioat; . Fee ~ubmitted S ............................. Construction on above described building and perr~'ir meets all appEca~la,c, Odes and regulations. THE NEW YORK BOARD OF FIRE UNDERWRITERS '~'~" BUREAU OF ELECTRICITY I~ ~ JOHN STREET, NEW YORK, NEW YORK THIS CE~I~IE5 THAT in the ~ollo~in~ Ioc~tlon; [] B~ernent [] 1st Fl. [] ~nd Fl. Section Block Lot wa3examlnedon ~)~O~b~.~ ~ lqT~ andfoundtob~in¢ompliancewlt~therequlrementsofthisBo~rd. FIXTURE L_ [ I RXTUIES [ IL&NOES COOIClNO Dr. KS I OVENS DISH WA.f~EIS EXHAUST FANS OUTLETS IBCRETACL~SlSWITClmSI,~A~DESCENTIFLUO~ESCENTI ~r~ [ ~T.I tW. I A/~T. IK.W. JAMT. I K.W. [ ~.~T.I K.W. ~A*.T.I H.P. DRYERS ] FURNACE ~OTOU I ,.tuRE ^,..,~ ~ .~c~.~. t~c~:- I -" ~ ~ wens x 1 tl?o 1 I ~/o 1 r*ettner Electric Co. P.O. ~o~ ~,q2 Rlverhead, I,I ll~)O1 Llc,~5~3-Z This certificate must not be altered in any mannerf, return to the office of the Board if incorrect. Inspectors may be identified by COPY FOR BUILDING DIEPART~. 1~15 COPY OF ~CIRTIFICATI MU~T ~ BI .&i.TBIID iN ~ Il TOWN OF SOUTHOLD OFFICE OF BUILDING INSPEOTOR TOWN OLERK'S OFFIr-E SOLITHOLD, N. Y. 319'73 STAUFFER INDUSTRIAL PARK / TAYLOR, PA. 18504 / (717) 562-0110 by Roycraft Here's the vacation home for the young at heart. Spaciously designed, the Sierra can fulfull your vacation home plans without costing an arm and a leg. Available as a basement model with two bedrooms or as a crawlspace model with three bedrooms you can provide the amount of space you desire. Beamed ceilings, open space, vast amounts of glass and lots of enjoyment are all designed into the Sierra. (The fireplace shown is optional.) You can make your own vacation hide-a-way dreams come true with a Sierra from Contempri Homes! ,562-0110 SIERRA VACATION SERIES MOE)~L 12-846V MODEL 13 - 846V MODEL 12 - 940V MODEL 13 - 940V There is 5 Contempri Home to please the most critical buyer. All include features that con- sumer surveys indicate the homemaker is seeking. Brand name appliances, famous name floor and wall coverings in an array of beautiful colors and textures. Add to this the easy living floor plans combined with the finest materiels, workmanship and Iow maintenance - your key to leisure living. STAUFFER INDUSTRIAL PARK Taylor, Pennsylvania 18504 Telephone 717 562-0110 STANDARD SPECIFICATION & CONSTRUCTION FEATURES 1978 STANDARD FEATURES FOR SIERRA VACATION SERIES ALL HOMES INCLUDE STATE AND THIRD PARTY INSPECTION AS STANDARD .... FLOOR: Double 2"x10" Perimeter Band Joists 2"x8' Floor Joists, 16" O.C, 5/8" Tongue & Groove Plywood Subflooring 3~" (R-11) Fiberglass Insulation (ship loose with Electric Heat only) WALLS 2'x4'' Wall Construction, 16" D.C. (both interior and Extetior studs) ~"* Y=" Drywall interior Wails in Kitchen, Bath, Hall, all Bed- rooms (Flat Finish) ~" Prefinished Plywood Panels in Livingroom and Dining area 6" (R-11) Fiberglass Insulation in Ceilings BATHROOM: Stacked Washer/Dryer Area One-piece Fiberglass Tub/Shower Unit Deluxe Vanity De~orator Accessories PLUMBING: SIERRA VACATION SERIES -- OPTIONAL FEATURES APPLIANCES: Refrigerator, 14 or 16 C.F.; two door (16 C.F. available w/~cemaker ) Deluxe 30" Range - Electric (with circuit) or Natural or L.P. Gas lelectric available w/self, leaning oven) Deluxe 30" Electric double oven range, with self-cleaning lower oven Dishwasher, 2 cycle installed Garbage Disposal, installed Portable 15" Trash Compactor (ship loose) Automatic Washer, topload, white only; shipped loose Electric Dryer, white only, shipped loose PLUMBING: Plumb for w~sher 52 Gallon Electric Water Heater 40 Gallon Natural or L. P. Gas water heater Showerfold Tub Enclosure, full bath Exterior Freeze-proof Faucet, rear of house Single lever Kitchen Faucet w/spray attachment Rolled-edge Counter Tops HEATING: Total Electric Baseboard Heat with, Individual Wall Mounted ELECTRICAL: Circuit for Electric dryer only Additional outside patio receptacle (front of house) Wire for Floodlight, specify placement Electrical Panel Box relocation, "A' module only T.V. jack HEATING ANO VENTILATION: Baseboard Hot Water Heat - Oil or Gas Bath Vent Fan, with light and separate switch iNTERIOR: Deluxe Shag Carpet %" Butt Edge S~bfloor with 5/8" T&G Plywood R-30 Insulation installed in Ceiling (rear of house only) R-11 (3%") or R-19 (6") of Insulation Installed in floor Basement Stair Opening, frame out, cut and enclosed with swinging door Colored kitchen & bath countertops Basement Stairs (opan risers) Drape Package 12" Paneled Feature Wall Wallpaper Kitchen or Bathroom. Refrigerator Overhead Cabinet Preway 35' Custom L~BOy Fireplace (shop loose only) Stone Face and Hearth (ship loose only) EXTERIOR: Manual or Electric Door Chimes AUTHORIZED BUILDER/DEALER: Deluxe Kitchen Cabinets Illtlll[ll~lllllllll by Roycrafl STAUFFER INDUSTRIAL PARK TAYLOR, PA. 18504 Telephone 717 562-0110 DUE TO OUR CONSTANT PROGRAM OF PRODUCT IMPROVEMENT, SPECIFICATIONS ARE SUi~JECT TO CHANGE WITHOUT PRIOR NOTICE FO~ NO. 1 TOW~ OF $OUTSOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ~'t~qL3r 1'7 19 78 Application No ...... C~J~. ................. Approved ........... ~'t?~Tr.~/' ....... 'J~ ....... , 19..r~j~ Permit No ...... 98]~9Z ................... Disapproved a/c ~ PEE~IT I'F:,f~LUDES APPROVAL. TO REMOVE EXCESS FILL FROM ABOVE PREMISp~;"~¥ ......... REGRADING t. OT ~ DRIVEWAY CONSTRUCTION ~-A CESSPOOL CONSFRUCTiON ~ - {Building Inspector) PLICATION FOR BUILDING PERMIT Date .............................. ]... ............... , 19 ............ INSTRUCTIONS a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, houslng code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. --/ State whetherapplicant is ~e,.agent, architect, engineer, general contractor, electrician, plumber or builder. applicant is a corporate, signature of duly authorized officer. ~' .................. ......... Builder's License No ..................................................... Plumber's License No ........ Z~,~,.~D~. ........................... ~<~ Electrician's License No .... ~...~ ............................. No ............................................... 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No ......................... N, b r ............................ Municipali~ 2. State existing use and occupancy of premises and incended use and occupancy of proposed construction: a. Exisiting use and occupancy ........... ~.~, ...................................................................................................... b. Intended use and occupancy ........... ~$[C~.~..~...~[~.~..,~.~.~ .................................................... 3. Nature of work (check which applicable): New Building' ......~: ......... Addition .................. Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work .................................................... (Description) 4. Estimated Cost ...... $.~(~¥0G0.,,0~/~.~0 .................... Fee ~2~i.%~/l~.~O~i~j..~.r~..¥i.ti.~.~..~t~i.~..~.~ii~i~i .................. 5. I~ dweliing, number of dwei[ing units ..~ ................... Number of dwelling units on each flo~. ........................ If garage, number of cars .........~..~..~.~ .................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number pf Stor~es ................................ 8. Dimensions of entire new construction: Front ..~.6.1 ....................... Rear ~;~t ................Depth ..~0.~ ........... Height .....~ ........ Number of Stories ..~ ............................................................................................................ 9. 3ize of lot: kront ..... ~0.~..0~ ..................................... Kear '~O~k~'t ......................... uep~ ~ ~"~'"~v0'~ ............ 10. Date of Purchase ...................... Name of Former Owner ~.,.~S~h~~.~.*~.~ I 1. Zone or use district in which premises are situated ...~. .............................................................................................. 12. Does proposed construction violate any zoning iaw, ordinance or regulation: .... ~ .............................................. 13. Will lot be regraded "~8 ...................Will excess fill be removed from premises: (X) Yes ( ) No Bo~ ~t~ L~ne 14. Name of Owner of premmses~.~t.~...~.;.~ ..................... ~e'~'~'e~'~__ ..... Phone No. Name of ArchitecGeO~$~..~....G&.[[~ ..................... Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM I_ocote clearly and distinctly oil buildings, whether existing or proposed, and indicate all set-b~ck dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. 3EE AT~ACHED .......... ~..v_.% ....... being duly sworn, deposes and says that he is the applican~ /(J~~ual signing contracf) above nam'~d. He is the .............................................. . . ............................................................... of said owner or owners, and is duty authorized to perform or have performed the said work and to make and file this application; that ali statements contained in this application are true to the'best of his knowledge and belief; and that' the work will be performed in the manner set forth in the g~plication filed therewith. Sworn to before me this ......... .................. ' BUILDI~[C DEPART~'~ENT T0~'1¢I OF SOUTHOLD, N. Y. HOUSING CODE INSPECTION REPORT Location 525 West Creek Avenue [number & street) ' Subdivision X Map No. X Cutchogue (Municipality) Lot(s) X Name of Owner(s) Auqust.ine.J. &. Georgina J. Gillen Occupancy ,, A~x~itted. by: Mr. Key ~vailable Source of request R-1 owner (type) "' [ owner-'~enant) -- Giilen ' , ........ n¢cQmpanied by' same t Suffolk Co. Tax No. 103-13-015 Augustine .G. illen Date 12/21/80 D¥~LLI~: Type of construction Foundation cement block Total rooms, let. Fi 6 Bathroom(s) 1 Porch, type Breezewa~ Type Heat eletric Fireplace(s) Domestic hotwater Other wood #stories one Cellar...partialCrawl space_~:.~est 2nd. Fi .. ~ 3rd. FI Toilet room(s) Deck, type wood ,,, Patio, type~ Garage under--oDe-Utility room Warm Air car Hotwater · No. Exits 2 Aircondition~ng Type heater -e~e~tri¢ $CCESSORY STRUCTURES: NONE Garage, type const. Storage, type const. Swimming pool .. Guest, type const. Other 6' hiqh wood fence ~ north side yard VIOLATIONS: Housing Code, Chapter 52 Location Description Nowhere violations--Housin~ found... Code~]Chap~ iThis, is an u,pdaqed C,O,: B.P. 9839Z issued 7/14/78--C.O. issued , 1/4/79, Z9371 (New dwelling) lB.P, 11199Z issued 6~22/S1-mQk (fence) Sec. Remarks: Inspected by: Curtis W. Hort6n 'Time start 12:00 end 12:30 ~OV~ jot~ now or formerly T. Beet)e , j NORTH CROSS ROAD Teat Holo loom ........ .......... HEALTH DEPARTMENT- DATA FOr APPROVAL TO CONSTRUCT ~rNEAREBT WATERMAIN~MI -+ N, SOURSE OF WATER, PRIVATEV/PUBLIC_- ~"SUFF. CO. TAX MAP DIST. SECTION BLOCK __ LOT "hTHERE ARE NO DWELLINGS WITHIN lDO FEET OF THIS PROPERTY OTHER THAN THOSE SHOWN HEREON. K-THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM FORTHIS RESIDENCE WlLLCONFOR· TO THE STANDARDS OF THE SUFFOLK COUNTY DEPARTMENT OF HEALTH ~ERVICES APPLICANT. -Z '"-' · =MONUMENT FOUND SURVEY .FOR AUGUST/NE GILLEN AT CUTCHOGUE TOWN oF SOUTHOLD SUFFOLK COUNTY:, NEW YORK · t+ THE LDCATION OF WELL (W),SEPTIC TANX{BT) (~ CESSPOOLS (DP)SHOWN HEREON ARE FROM FIELD OBSERVATIONS AND OR DATA OBTAINED PROM OTHERS. ~ GEORGINA J. GILLEN oc~ 27./~7~ OCT 17, 1978 DATE JUNE I, SCALE' I": NO = 78- ,M, UNAUfHOR'IZE~ ALTERATION OR ADDiTiON -TO THIS- SURVEY IS ~ VIOLATION O~ S,~DTION 7209 OF THE NEW YORK STATE EDUCATION LAW GUABANTE~D TO: THE TIT~E GUABANTE£ CO. AUGUST/NE ~ GEOBGINE d. MENTAL AG~ENCYAND LENDING INSTITUTION LISTED ~ NEREON~ANQ TO THE ASSIGNEES OF THE LENDING /I & :m I HOWARD W, YOUNG, LAND SURVEYOR N~LIC[NS[ NO 45893 ~VENUE YORK ~0~ jo~~ NORTH CROSS ROAD rwat Hole loom son# .......... IZO ,SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES FOR APPROVAL OF CONSTRUCTION ONLY APPROVED HEALTH DE'PARTMENT" DATA FOR APPROVAL TO CONSTRUCT 'Xr NEAREST WATER MAIN~. MI, 4. ~. SOURER OF WATER' PRIVATEv' PUBLIC --- ~'SUFF. CO. TAX MAP DIET. ~ECTION BLOCK , LOT ~THERE ARE NO DWELLINGS WITHIN IOO FEET OF THIS PROPERTY OTHER THAN THOEE SHOWN HEREON. ~THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM FOR THIS RESIDENDE TO THE STANDARDSOFTHE SUFF LK COUNTY DEP~TME~T OF HEALTH $ERVlCE9 APPLICANT: · =MONUMENT FOUND ~THE LOCATION O~ WELL (W),SEPTIC TANK(ST)I~ CESSPOOLS (CP)SHOWN HEREON ARE FROM FIELD OBSERVATIONS AND OR DATA OBTAINED FROM OTHERS. SURVEY FOR AUGUS TINE 'GILL EN Et GEORGINE J. GILLEN AT CUTCHOGUE DATE dUNE I, 1978 TOWN OF SOUTHOLD SCALE 1% 40' SUFFOLK COUNTY, NEW YORK NO 78-288 THE TITLE ~CGmES OF THIS SURVEY NOT e~Am~ ~H~ SORyEyOR'S INKES SEAL OR EMBOSSEO SEAL SHALL AUGUSTINE~ HEREON,AND TO THE ASSIGNEES OF THE LENDING J TO EXISTING STRUCTURES ARE FOR A SPECIFIC ' PURPOSE ~ND ARE 'NOT TO BE USED TO ESTABLISH J ~ ~ ~ , ~ .... ~ ' JJ~J J /gUl~g a 1gUl~g RIV[RHEAD,NEWYORK & ~/ HOWARD W. YOUNG, LAND SURVEYOR ~y 'BJ N.Y,S, LICENSE NO 45893