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HomeMy WebLinkAbout10589-z FORM NO.4 TOWN OF SOUTHOlD BUILDING DEPARTMENT T own Clerk's Office Southold, N.Y. Certificate Of Occupancy 210075 Date.,. .~~~~. ~'~""""""""'" 19, ~9 No......,...,.., . , . THIS CERTIFIES that the building, , . . . . . . . . . , . . . . . . . . . . , . . . . . . . . . . , . , . . . . . . . . , . . . Location of Property .... .3:-1'19. .~~~. .q~~~~,e~t. . . . . .. . .F;~~:t.~~r~~.~J., ~.~~ .1~:r:~. .. . House No Street Hamlet County Tax Map No. 1000 Section ... .,q, . . . . .Block . .? . . . . . . . ., . .Lot ' . . . ?.4 . . . . . . , . , . Subdivision. .?~~l:1J,~. ~Ei)~9h. .F:~. ., . ,. . . .Filed Map No. 6.266. .. .Lot No. ... .?3. . .. . .. conforms substantially to the Application for Building Permit heretofore fIled in this offIce dated . . , . .~?!:r:~~. 7. . .. . . . ., 19 .~9pursuant to which Building Permit No. ... ;J,Q5.~9. .4.. . . .. .. . d t d March 20, 19 80 ' d d f t 11 f th . t a e ............................ . . . , was issue ,. an cqn arms 0 a 0 e requuemen s of the applicable provisions of the law. The occupancy for which this certificate is issued is . , . . . . . . . ..,..,..... )):r:.J,y~:t,~ .qz:1~:-:~~~;L'y' .~,e.:q.-1-~g..,......,...........,............, The certificate is issued to .,..,. :~s~.eh1~~ .~~, ~~~~. A1':'~~~~ . . . . . . . . . . . . . . . . . . . . . (owner,/~s~ of the aforesaId building. Suffolk County Department of Health Approval ..,...... ~9:-.~<?7?~. . . . . . . , . . . . . . , . . . . . . . . . N 488912 UNDERWRITERS CERTIFICATE NO. . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . , . , . . . . . . . . . . . . . ,.,~.~,7I.~......... Building Inspector Rev 4/79 I , ~ ~~~.~ , j, "" .",.. ._'-" Jl}fuLf~ ". II FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE pREMiSES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 10589 Z Date ..M;(!./..(c.f!....Z(,) ......... " 19j(), Permission is hereby granted to' .....7{i.f:I..........C.~M.$..T..{b/.(:E.,.., , .. -?g~ ~ ~ ....?...'.i......,.. .I.'(":'.?ic..t..;,!/E/CE., ~, . liy?:&;i..c.t:..,......L:...,Sf.."... ,.... , ..' to .....e.Qt/....m2Ctr!./..:....(.;/.'-'E.....&)~/.LZ......~.E.II~ . .... "..........." ,. ...............~.I.,.......,Zi.v.L"..:?,(./I..t?E...f( ,Lt.. 6/....,#/..?A7'-.. ~/.:, ,..,......,....,.. ot premises located at#..l/.'j:.O.....~...C.i;,.:f{;;:':?$1dT'l"...t-:.~,~(OIJ7"1J /- ..(;.j................-."'........................ "................. .. ". .. ...,...,."............,...,..,................... ,..' .."." ".....,...... ~!:F.;l;:0'.t:..5~...~&I.~.......4C!7.#..~...........,.,................ .",.. ..."",........,...,. U ,1 pursuant ta application dated .. ~r:d...., 7..,.." ... ,........" l~O..., and approved by the Building Inspector. / Fee $Z?..~~..... i <\ _... , j "'~ ,~t ' .~ I FORM NO.6 TOWN OF SOUTHOLD Building Department Tawn Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructians A. This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tar with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, praperty lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposal-(S-9 form ar equal). 3. Approval of electrical installation fram Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tians, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Baard approval af campleted site plan requirements where applicable. B. For existing buildings (prior to April 1957). Non-canfarming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topograph ic featu res. 2. Sworn statement of awner ar previous awner as to use, occupancy and condition of buildings. 3. Date of any housing code ar safety inspectian af buildings or premises, or other pertinent informa- tion 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 Date. JJ. ~.J:?::.....if!.:'.... New Building. .( . . . . . . . . . Old or Pre-existing Building ............ Vacant Land ............. Lacation ofPraperty !/./C? .}.ft.~... ~4f-;~~'.~'tI:~......... .~'1?!... h.1.1!-:t.'?';-J:.. "-;;/.:' House No. Street Hamlet Owner or Owners of Praperty--r:S.l;J. ~)g.'. H: \.\).~... .f.\;.~~.. ?1.~-/~.... .\1R&.~.~'f;.\...... .-~ 0 'l-- k-1- Caunty Tax Map No. 1000 Section ..~............ Block............... Lat..... .......... S bd' . . PE' bb\@ \6",,.,<.L, 'i=S>..~~. F'I d M N :tf:p.:> u IVISlan.. .....~.......',............... leap a. ......... .Lat No. . . . . . . .-? . . . . Permit No.l~f>.if.'l... Date of Permit 7>flcf.Q. .Applicant :f.Gh.. .4<:!'?!:T.I~.. .0?fcf...... Health Dept. Approval . /.W:~:'.: ?-: I. .. .~.;lJ>:'. . Labar Dept. Approval ........................ Underwriters Approval ):\ .I-J.!??: 1.1.?-:. . . . . . . . . . .Planning Board Approval. . . . . . . . . . . . . . . . . .. . . . Request for Temporary Certificate. . . . . . . . . . . . . . . . . . . . .Final Certificate. . . " . .~. .. . . . . . . . . . Fee Subm itted $ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Construction on above described building and perQ:iit meets all applicable codes and regulations. _ ",." Ap,I;"" . k:tP.I1f' .. . .. . .JI;!~~~1. .. . . . pF 4- I t' ! ;" ,,1;. ,j ,>:,1. T 1i ,~,' ,."C )~. ." d:, , - - - ,- ~, -_.~" -~..... ~-~....._~- ~~ ---~-- -~ " 0 ,,",',.- "I~ ,'i ., .', -t . , '.. ,j.'.- . I f~-!., ';. 'i " :.- S.... 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I~ "- ROUGH FRAME & ~~ f'';{J PLUMBING CS ~ ~I 3. ~~ - INSULATION PER N.Y. ~k' ~' STATE ENERGY '\ CODE ~ , .:r:~ 4. , _ iD 1'\ L ~" - ~~ FINAL , - 2~~ g'" ADDITIONAL COMMENTS: 'i -~---- dU/~ IO')t(t' I ~~- /,J.:. x: ~ 17 ~ '.:):; /A/4I'~~.,.{ ~/~~'C 714 Iqo~ ~ ~ - ~70cl " " " ~J .(1 r ~ I-',".S.. ~~ ~~ 0,,", ::s ~ ~ (cJ L./.( ( f- ':Ij" - ... ,. . ~ 0 .' ~I .~~ CD I IT(\( . I j t:iL "it. ;;1,:, ~--... c. , _d. -", ,""" ., fORM NO.1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765.1802 Examined fI,Mi( ('t/. ZC. " 19 rr" Application No/v ::,;:(,?:j........ . Approved HpA.:,(/f.'. .i:u.. ., 19c6. Permit No.j0 ~~(<r tf Disapproved afc . . . . . . ... ~:~:~:-:': -:-: . . . . . . . . . . ' , . , . ./: , .--- . / .'.........',.,.................. '{~~'?' $~' ...( ,~ . ~..., (~ ing Inspector) APPLICATION FOR BUILDING PERMIT '? ... 7 ' 1?" ...,1" Date. . . . . . . . . . . . . . . . . ., 19 : . . INSTRUCTIONS a. This application must be completely filled in by typewriter or in mk 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 of property must be drawn on the diagram which is part of this appli. cation. 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 is~ue a Building Permit to the applicant. Such permit I 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 i 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 eomply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. .-:r~~.I~.. .<;q:~~~~...~ :.~/:.................. (Signature of applicant, or name, if a corporation) )~~f.y.. ~I. ~.1?~. ~:' ::'.t. :2.,:. . :,:C.. ~'\. :. ~; ,~.~ '''~' < (Mailing address of applicant) '.. ~ v (, , I State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~-.J\....\),..:;p- .... ..........,.......................',.... ,............. ,.. ,.... ..... ................,..... ... . -r;;VNI.:'/-f/!.<5' /:\V\,> J..I/..I-\ A\2.,;;(.d\\~1 Name of owner of premises .....,..........,............................................,.......,..,. ;i (as on the tax roll or latest deed) , IT ,,,li,,,' . , "'''''''?~ '"",,'"w ~ f d >>1y ~tl"',"'d ,moo,. <,(!!.~~ ~~l~ ~ ;i ~;;;~r~t~~;;~~r)! .l"".~ : , . Builder's License No. .......,.......,....... '. . ,)" (.;) PI 15' L' N j (, · urn er S lCense o. ......,.........,......., El t" 'L' N q I ~; c: ec nClan s Icense o. ...,...."............ Other Trade's License No. ....., ..... ,........ /... t! ;42 ,j -1' .' f" " \'\ ' , 1. . . . 01';;;; UL ,:.,jt>tL> t.~;(,I' 'j ,'~ ~ .~ LocatIOn of land on which proposed work will be done. ....,........,.............;,.................,.,.. .:Iu'lllo:!!:u~ b~; . '! .t. ~ ~ . ~ .~. :: . . . . J. <'1:". ~tr~~t.?~ Y: .' :". :-!, . . . . . . . . . . . . H~;;l~t . . . . . . . . . . . , . , . . . . . . . , . . . 3J ~ ~t County Tax Map No. 1000 Section .. .". . . . . . . , , . . . . ., Block....... . . . . . . . . . .. Lot.......,............ (,J.." '."~'\'I'\ '-p,lfl4j' k.";2c;, S bd' . . , ,. , ( ... C \ "- ' '. .. !' F'l d M N L t #.. r U IvlslOn..... ~ . . ' ;' . . " ....,.,............... 1 e ap o. .............. 0.........,..... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: \i '. . - L...,' 1-' E" d 14-\I,"\~Jl"! a. xlstmg use an occupancy ,. . . . . : . . . . . . , . . . . . . . . . . . . . . . . . . \ ' , . . . . . . .. . . . . . . . . . . . . . . . . . . . , . . . . . . , - 'G ~ \.' ~ \. ~ -,,( ! \' " '- '. ,--' b. Intended use and accupancy ..). .": . :... . . . .'. . :: .'. :- .'....... ,I. . . . . . .I,L;"~ .'~ .' ,I. X, :": . (. :. . . . . . . . . . . . . . . . . . . l i '),.b. " i. " ,," ""A,:';. .d_..ii'L:;;.~.. ".r-_ ,i,i?h ;',1 1d>....~"d'--__"'.h ;,_~..{", ,"" ,;. ) 3. Nature of work (check which applicable): New Building. .1. . ',' , . Addition. . . . . . . . .. Alteration .......... Repair .............. Remqval . . . . . , . . . . . . ., Demolition .............. Other Work. . . . . . . . . . . . . . . " : j #J a (Description) 4. EstimatedCosj,. L-/Q.,.';;.'?-?i......................... FeY.Jr................................. " (to be paid on filing this application) 5. If dwelling, number of dwelling ,units. . . tJ.t,).t:. . . . . " Number of dwe]Jing units on each floor. . . . . . . . . . . . . . . . If garage, number of cars .-:f't<!.?................................................................ '6. If business, eommercial or mixeli oecupancy, specify nature and extent of each type of use . . . . . . . . . . . . . . . . . . . . . 7. Dimensions of existing structur~s, if any: Front. . . . . . . . . . . . . . . Rear .............. Depth............... Height, ............... Nunjber of Stories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . Dimensions of same structure with alterations or additions: Front ................. Rear . . . . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . . . . . ~ . . Height . . . . . . . . d. . . ". . . . . . . . . Number,of ,stories . . . . . . . . . . . . ., . . . . . . . . 8. Dimensions of entire new construction: Front. $.0., .6. . . . . .. Rear. .:$.7..t. . . . . . . . Depth . ~ ~ . :-. . . . . . . Height . ::>'':7 !. ,-. . . . . . Nu~ber of Stories. . ,O~.r;;. . . . .'. . :'. . . . . . . . . . . . . . . . . . . . . . . . .!. . . '. . . . . . . . . . . 9. Size of lot: Front. ."7:lI.'a 'J. i........... Rear... ?:!..??.......... .Depth. 11,' .~?:: .'::!l..... '..,... 10 I) fP h /a";'Q' N fF 0 't't'5e.L~ at/Hr' ,.."IIL.T;.' . ate 0 urc ase . '7' ."..,..'. i . .. .. .. .. .. .. . .... ame 0 ormer wner ............................. II. Zone or use district in whieh pr~mises are situated () N 1:. . . P."~.":< .\\>.1. . . 14,,,,',,:I1)),c ~ n ~ ,I.,- : . . . . . . . . . . . . . . . . . 12. Does proposed construction violate any zoning law, ordinance or regulation: .~. -;.'.:! . . . . . . . . . . . . . . . . . . . . . . , . . . 'j ]3. Will lot be regraded ...~.? i . . . . . . . . . . . . . . . . . . . Will excess li I be removed from premise!!,; '\. Yes I ;No , .! ~q"I>"'\ ~Q"; \i/.~l'A~~ ,/of -'''',2- ""0;1.:. ]4. Name of Owner of premIses t!f.. .II.:. . . . . . . . . . . . . . Address. . ~ ...,.\1." ,I.\<-. .H~'. Phone Na. ". .,/f.. "'""Ii?' . . . . Nam fA h't t .-::'''1.'',0, >>1;:J1 \ \/:':) Add <"I-ft.". "'., Ph N r...;;!,j ~ <Ix ,I eo rc 1 ec 4"' ~ . i . . . . r, }.'. . . . . . . . . . . . . . . . ress ...... . . . . \ . . . . . . . . . . . . one o.......f.o'. F, Y. . . . NameofContractor-:r:IJ,.I1.lc?4n,(!.:.l7:'~.. . . . . . Address !"/,I'Jhl.~. .'-:,1:. . . . . Phone No.t?'?t.if!!. . .. . . . , , PLOT DIAGRAM Locate clearly and distinctly all buildings, whether eXisting or proposed, and, indieate all set-baek dimensions from property lines. Give street and block! number or description according to deed, and show street names and indicate whether In'erim m ,~oc 10',; r ~ I... ~ '1"# f (It;.:;>>"'" If i- 4.1 ~ - '1 '-4 (j fQ. ... -..0 ~ '.. ..,. ... - f\ ~ '- t> If! '\~ C) \1\" t.y\.: (\ ..... ....\ . I~::io- . I STATEOFNEWMRK, /.! S.S ' COUNTYOF...",.:..:>~ .ff'; . .4:"':. . . W'j' /..-1.:. 'bf!' !"":1 . . . . " .p",. PP.A~ . . . . . . . . .. being duly sworn, deposes and sjlYs that he is the applicant' Y (Name of individual signing contract) , \ above named. i \ , He is the .. . .. . . , . . . .. . . .. . .. L . .. . .. w.?' ~1)? ti. 0":';;: (l...... . . . . . . .. . .. . . .. .. . .. . .. . . .. f, .. . .. . . ..... .. , ! (Contractor, agent, corporate officer, etc.) , ' of said owner or owners, and is d~ly authorized to perform or have performed the said work and to make and file this applieation; that all statements eOIJtained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manl)er set forth in the applieation filed therewith. Sworn to before me this I . . .. .. /0't1.\. ., . . . ., .. .daY?f.. . . ./1<; <:lA-vi. . ...,19<1"\5>. Notary Public, .........,..... i2~/ q;ffplj:. County L- ')r;i'" '~;; '1/ /,\ _ I ,U ,'-' "'M /-"/' 1- ,)/rG ~,.- . . C4(}:/,ftv' a a. ~v ., LE .. #. ... ..U' ~. .. .. . .., .. .. . .. .. .. .. . !:' [LIZABETH ANN N J (S' t f I. t) i' N011\RV PUBLIC, St,t, 01.~W Vor> 19na ure 0 app!Can 'I No. 52.8125850, ~uffol unty " lerm EKplres Marph 3. 9_ - '; . ., (1,395.00' I" (,'I It. ~ "~......... -\ "I. '" G> ?::) '" '" "Z. ~ -\ ~ "I. '" \: V> ?::) ~ \'" 24 -- :. (J) \ [..ot "'- () - o '" o. .; ~s. '" ~ ~ ~1 ':" ... i..\..1.A , o ,,' \ -~ ~. .. \ ~J" , _-- tV' ~ .......''00. '!. 10. 21 ~ '::> 282.2 .("C. 0 le( 5 $. "a 0 -' ..- ~ -- ~ ~ ...." 23 I sf. '" '0 [..ot _ 21,16 '" ~ '? p.p.fJ>. - 1'1> ~ '<. -:'\ 22 7"\ [..ot ?<. '::> "" \ \ \ \ SUFFOLK COUNTY HEALTH DEPABTMEN! SURVEY FOR.. TSUNEH/OE ARAGAK/ a LILA ARAGAK/ LOT NO. 23, "PEBBLE BEACH FARMS" AUG 12, 1980 0' 'rE "i: 'i9Hf) H. D. RE1'. :1i'dl-6a~1 MAY 15, 1980 ." . l.1.!.J._\.L_L. __ '.:._;...:?__~ MAR 19, /980 i'hr1 ~1'Y;:-'( ;.,t) f~.: '.> '(\';-",! /", ' -' i~ " '~, ' ~) '1 Y AT EAST MAR/ON DATE SEPT. 10,1979 raG ~ ~ j t, i.~" 11 _' , " '~) r ( en TOWN of SOUTHOLO SCALE 1 "= 40' ln~)jYJclu(' i \{ l )1 J ' I, ! -',I il" I,d SUFFOLK COUNTY, NEW YORK NO 79 - 501 to bo srttiFJll-~. ;''"J', J, / J . , * LlNAUTHORI;:ED ALTERATION OR ADDITION TO Tl-iIS J <I /~J/ }j' I Vt-1 GUARANTEED TO' v \ '" '/_-..", 'z' .t-., t. ,", .)' SURVEY IS A'VIOLATlON OF'SECTION 7209 OF THE NEW VORl<- ST(4TE EDUCATION LAW THE TITLE GUARANTEE Co. Cbicf of CCiJnptll l';nglnoet'lnlt" ,- ... COPIES Of THIS SURVEY NOT BEARING THE LAND Sr,rvices sURV~YdR'S dNKfD SEAL OR EMBOSSED SEAL SHALL EQUITABLE FEOERAL SAVINGS SLOAN NOT BE CONSIDERED TO BE A VALID TRUE COpy ASSOC, ~GUARANTEf:~ INDICATED HEREON SHALL RUN ONLY TO BOWERY SAVINGS 8ANK HEALTH DEPARTMENT -DATA FOR APPROVAL TO CONSTRUC T THE PERSON, QR WHOM THE SURVEY IS PRE.PARED AND ON HIS "EHAlF TO HiE TITLE COMPANY, GOVE.RN- M NEAREST WATER .AIH_MI ~ }II; SOURCE OF WAnR PRIVATE _ PUBLIC..! MENTAL !AGENCY AND lEHblNG INSTITUTION LISTED " SUff co TAX MAp OIST!J!H SECTION H- BLOCK ....L- LOT ~ HEREON, AND 'TO THE ASSIG:NEES OF THE LENDING )t THERE ARE NO DWELLINGS WITHIN 100 FEET OF THIS PROPERTY INSTITUTION :GUARANTEES ARE NOT TRANSFERABLE OTHER THAN THOSE SHOWN HEREON TO ADDlnON~L INSTITUTIONS OR SUBSEQUENT }II; THE WATER SUPPLY AND SEWAGE DISPOSAl,. SYSTEM FOR THIS RESIDENCE OWNERS WILL CONFORM TO THE STANDARDS OF THE SUfFOLK COUNTY DEPARTMENT -ff DISTANCES, SHOWN HEREON FROM PROPERTY LINES OF HEAL TH SERvlcrs fO EXISTING, STRuCTURES ARE FOR A SPEClfI"lC APPliCANT, PURPOSE., Ato(D ARE NOT rp !!IE USED TO ESTABLISH PROPERTY LINES OR FOR THE ERECTION OF fENCES ADDRESS ~-~--~- YOUNG 8 YOUNG TEL . =MONUMENT ALDEN W YOUNG, PROFESSIONAL ENGINEER tJ = STAKE SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERK OF SUFFOLK COUNTY AND LAND SURVEYOR N Y.S LICENSE NO 12845 ON JUNE II, 197!i AS FILE NO 6266 HOWAFlD W YOUNG, LAND SURVEYOR * THE LOCATION OF WELl(W),SEPTlC TANK(STI&,CESSPOOLS(CP) SHOWN HEREON NY S LICENSE NO 45893 ARE FRO" FIELD OBSERVATIONS AND OR DATA OBTAIHED FFf'OM OTHERS I,) ( f'u'.! UI"1 .. ,~, H ';' f?i395.00' 9 16 ~ \ ~~t ~ ~ J~~ I m '" G) ~ '" '" Z ~ ~ ~ I '" '" \t": ~ \~ Z4 0 ~ \ [..ot ~ ~ ~ Z . ~ f.: "~ ~ ~ '?;~.. ~ c:I. ~"" .A~~ .:.:.- '0 \~t" \ "';c:-'! "'. ,. \ ,~J~ t,.A~'" ;. %~ ~ ~ -~ ~ ~ ----- -.... fZ "...:,..J;~,1;;> ) o ;t~~^" \ ~.--'- .,}2 '0 Z:3 61S.f. ,>' ""' [..ot 21,1 ~ Cp.' ~ a> p.p.. v, .." ~ \;>/) _ i~'" .) "< <1',.../.;> c. <:t> ~ G D.". . 2 {;; 1,>r'~ ~ ~t ~ ^ ':> .a \ , , "). ').. 0 '\ 'I \ SURVEY FOR' f{SUNEHIOE ARAGAKI 8 LILA: ARAGAKI LOT NO. 23, "PEBBLE BEACH FARMS" SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES AT EAST MARION DATE SEPT. /0,/979 FOR APPROVAL OF CONSTRUCTION ONLY TOWN OF SOUtHOLO SCALE, / "" 40' '7.//I/frY cs. SUFFOLK COUN'tY,NEW YORK NO 79-50/ DATE 1 1/. HS REF NO.-LO. lI. ~I ' . jIf uNAUTHORIZED ALTE.8ATfPN OR ADDlflON TO THIS ~ SURVEY I~' A VIOLATION \OF ,EC:TIOH 7209 OF THE ",- NEW YORK STATE EOUCA'tIOfi LAW APPROVED " !if COPIES ,Of THIS SURVt:!:V N,OT SEARING TH:E LAND SURVEYO"'S !NKE D SEA};. OB ENBOSSED SEAL SHALL NOT BE CONSIDERED TO, BE. VALID TRUE ,COPY .-GUARANTEES IHDICAtEl> H~REON SHALL RUN ONLY TO HEALTH DEPARTMENT -DATA FOR APPROVAL TO CONSTRUC T THE PERSON FOR WHOM ,.THE! SURvEY IS PREPARED AND ON HIS BEHALF TOj)rHE,TITLE COMPANY, GOVERN~ '* NEAREST WATER .AIN_NlI :!: M SOURCE OF WATER PRIVATE _ PUBLIC.!.. MENTAL AGENCY AND LB,..OUfGINSTlTUnON LISTED * SOfF CO TAX MAP CIST IJ!.Qfl. SECTION.H...- SLOCK L- LOT ..B1- HEREON, A,frfO TO THE A~SIGHI!ES OF THE LENDING *THERE ARE NO DWELLINGS WITHIN 100 FEET OF THIS PROPERTV INSTltUTlQN GUARANTEIS)I.RE NOT TRAN$FERABLE OTHER THAN THOSE SHOWN HEREON TO ADDITIONAL INSTlrU;rION~ OR SUBSEQUENT * THE WATER SUPPLY AND SEWAGE DISpOSAL SYSTEM FOR THIS RESIDENCE OWNERS WILL CONFORM TO THE~T NOA~D OF THE ~u 01..1< COUNTY DEPARTMENT '* DISTANCES SHOWN HEREON FROM PROPERTV LINES TO EXISTING STfWCTUR(S 'ARE FOR ASPECI'IC OF HEAL TH SERVICES - W PURPOSE .AND ARE NOT TO I!!IE USED TO ESTA8LISH APPLICANT- " " .--r<01M eA;:1N)J"7fl.." C,oL.~ PROPERTY LINES OR Fq~ THE ERECTION OF fENCES ADDRESS S 10 f11 (i'fZlZ( C /::.. I1Jt:. M 8/2 (L{ c ~ ~ !lstt TEL511 ,6.21 ;Y"Plj YOU NG a YOU NG RIVER~EAD, NEW .:oE:~E · :MONUMENT ALDEN WYOUNG,PROFESSIONAL ENGINEER ANI;> L/jND SURVEYOR N Yo'S UCENSE NO,I2845 i' HO\>;ARO W YOUNG, LAND SURVEYOR * THE LOCATION OF WELL(W),SEPTlC TANK(Sn& CESSPOOLS(CP) SHOWN HEREON NY. S LICENSE NO 45893 ARE FROM FIELD OBSERVATIONS AND OR DATA OSTAINED FROM OTHERS ' T DY POST l 049~