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Home My WebLink About14254-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No...g. 1.5. .67.6 ......... Date ...A p.r.i. 1...2.2.,...1.9.8.7. ............. THIS CERTIFIES that the building ..... O.n..e..f.a.m..t .ly.. d. ¥9.1.1. t..n g.. .................... Location of Pronertv 235 RABBIT LANE EAST MARION House No. Street Ham/et County Tax Map No. 1000 Section ...q 3. .1 ...... Block ...l.7. .......... Lot ...0.q 9. ........... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... .A.u. ~ :..1.9. ,...1.9.8. 5. pursuant to which Building Permit No.. 1.42562, ............. dated .... .S .e.p.t.: . .9.,.. ] .9 .8.5. ........ was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... ..... ?~.. ;?.m. ~..~ y..d?. ?.~.Lt. ~..~.,.~.~. :. ?.~.e' . ~. ?.d.~?.. ?.d...d.~.~?.~.: ....................... The certificate is issued to DEVTN GROUP, LTD. ..................... io~n'~;, ~6~'6~'x'~ ................... of the aforesaid building. Suffolk County Department of Health Approval .... $.5 T .S .C).-. 2. !...~. a..r :.. I. 7.:..1.9. 8..7 ........... UNDERWRITERS CERTIFICATE NO ........... .~.7. 5. .8.6.4.5. .... ~.u. [..v.. 1. 5. :..?.8..6 ........... PLUI~BERS CERTIFICATION DATED: July I7, 1986 Building Inspector Rev. 1/81 NO. ~ TOWN OF $OuTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, bi. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 14254 Z Permission Is hereby granted to: .... . .~.,,,/~..~...:;'~..~,.~.....~..,,/~......./..~.. ......... ....... ..................................... .... ,~...C; ........................................ ,o ....... ~Q z~.~ Z.~. . ~ ~. Z T:. . . . . .~ ~.~. . . . . ~.~. ,,N-z~. /. . ~. ~. . . . . z,~_,~,. .~. . ~Z~ ....................... County Tax Map No. 1000 Section ....(~...~.../. ...... Block ..... /....~.. ........ Lot No...(~.....O.....~'.. ....... ~,.~n~ ,o o~p,,~,,o~ doted ..~.~.~..[.~:..'~ ............... . ~.Fond o~.o.e~ ~ ,~e Building Inspector. Rev, 6/30/~80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted im,-,-.,~ to the Building Inspec- tor 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-iS-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and sifnilar buildings and installa- tions, 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1, Accurate survey of pZOperty 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. C. Fees: 1. Certificate of occupancy ~,~5.00 ~) 2. Certificate of occupancy on p~g dwelling $ :[5.0 0 3. Copy of certificate of occupancy $1.00 4oVacant Land C.O. $5.00 5. Updated C. O. $15.00 Date .......................... New Building . ..~. ......... Old or Pre-existing Building ............ Vacant Land ............. Location of Property .',~.. '~. ~ ............. ~.,~ ..~J/..~. ~,~ .,~ ............. y/c~,._,o ~ House No, Street Hamlet Owner or Owners of Property ...... .~??... ~'f o~, .~.. '/', Z ~--~J County Tax Map No. 1000 Section ... (;~2. ,,~. ~ ...... Block ...J..~. ........ Lot ...... .¢ .....'.. Subdivision ................................. Filed Map No ........... Lot No ............. Permit No././%/.~?. ?~--T. Date of Permit ~h/$~'..Applicant .... /..~.~. r~....~.?.~'y..L ~.~ ...... Health Dept. Approval ~. ...................... Labor Dept. Approval ....................... Underwriters Approval ~. ~. ~. F~..~.~.~. ...... Planning Board Approval ..................... Request for Temporary Certificate...J~. ................. Final Certificate ...................... Fee Submitted $ .................... Construction on above described b regulations. Ap~J-- .~-~¢~'~.~...,~, --,.,.,.,.,.,.,.,.,.~Z. , ,-~,-~, ................. TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Building Permit No. Owner -T. & (please print) (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Sworn~o beforeS, /Vl'~ay of /~ Notary Publ ic~, ~, (plumber' s signature) --Notary t~ublic unty YORK BOARD OF FIRE UNDERWRITERS "~ '~ ~"'" il ''* r,. !~ BUREAU OF ELECTRICITY ,' ~ rI , ,~ '~ ~ ~r ~ ~BB JoHN ~TREET,.NEW YORK, NEW YORK 10038 ~, , I, I, R G~S~E]ectric?, . , BOx 215 Southold F,:~. Y.'i 11971 Lic. 578E ~! ;''~ GENERAL This certificate musl. hbt be alt~t'~&d in any manner; return to the offsce of the Board if incorrect: Inspector~ may be identified by their~i~:r~dehtioIs. FIELD INS?Eg,~ION, COMMENTS FOUNDATION (1st) FOUNDATION (2nd) 2. ROUGH FRAME & FLUMBING 4 INSULATION FER N. STATE ENERGY ~ODE FINAL '~. ok-' f.,c,, C " ADDITIONAL COMMENTS: Memorandum from.... BUILDING INSPECTOR'S OFFICE TOWN OF SOUTHOLD TOWN HALL, SOUTHOLD, N. Y. 11971 765-1802 April 8, 1987 Dear ~r. Dowd: I received your Board of Health approval today. I am returning the check that ~as in the folder. It is outdated. Please send us a new check so that we can issue the Certificate of Occupancy. Thank you Secretary Please put on your check for B.P.#I4254Z The Devin Group Ted Dowd 201 13th St E Tierra Verde, (813) 86? 2761 33715 BLDG. DEPT. ~.,,~WN OF SOU'fHOLO Mar~h 30, 1987 Attached is the final approval from the Health Dept for Building Permit Nr 142~4Z. The approval had been held up due to legal requirements in providing an easement to the well ~or the property, This should be the last requirement for the permit, If there are any further questions or problems please contact me at the above address. NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION PERMIT ' PERMIT NO. 10-84-1355 UNDER THE ENVIRONMENTAL CONSERVATION LAW [ ARTICLE 1.5, (Protection of Water) [~ ARTICLE 25, (Tidal Wetlands) ARTICLE 2e*, (Freshwater Wetlands) L.J ARTICLE 36, (Construction in Flood Hazard Areas) :'ERMIT ISSUED TO Ted Dowd Tierra Verde, Florida 33715 OCATION OF PROJECT (Section of e/ream, tidal wetland, dam, buildi0g) NOrth and south sides of Rabbit Lane, Marion Lake and Gardiners Bay, East Marion. IESCRIPTION OF PROJECT Construct a single family dwelling on south side of Rabbit Lane approximately 19' landward of mean high water ~ardiners Bay). Install sanitary system fo~ this lot on applicant's property on the north side of Rabbit Lane, approximatel ~1~50' landward of mean high water and 125' south of Lake Marion. Construct single family dwellings with decks on north side of Rabbit Lane ***(cont. on :OMMUNITY NAME (City, Town, Village) J TOWN back East Marion J $outhold :OUNTYsuffolk E~a COMMUNITY NO. DAM NO. PE~t~T6/30/87EXPIRATION DAi~ GENERAL CONDITIONS 1. The permiltee shall file in Ihe office of the appropriate Regional ~rmit Administrator, a notice of Intention to commence work at least 48 ~urs in advance of the time of commencement and shall also notify him omptly in writing oJ the complelion of the work. 2. The permitted work shall be subject Io inspection by an authorized presentative of the Department Of Envltonmontal Cooservation who may der the work suspended if the public interesl so requires. 3. As a condition of the issuance of this permit, the applicant has ac- ~pted exp,essly, I~y the execution of the appllcalion, the full legal respon- diity for ail damages, direct o, indirect, oJ whatever nature, and by whom- er suffered, arising out of the project described herein and has agreed to lemnity and save harmless the State from suits, actions, damages and ~ts of every name and description resulting from the said p,oject. 4. Any material dredged in the prosecution of the work herein permitted all be removed evenly, without leaving large refuse piles, ridges across lhe of the waterway or flood plain or deep holes that may have a tendency to c~use ieju,y to eaviRable charmets ot to the banks of the wale,way. 5. Any material to be deposited or dumped under this permit~ either in t~e waterway or on shore above high.water mark, shall be deposlled or dumped at,I the locality shown on the drawing hereto attached, and, if so ~'escribed thereon, within or behind a good and substantial bulkhead or bulkheads, such a~. will prevent escape of the material into the waterway. i 6. There shall be no unreasonable inte,ference with navigation by lbo wirk herein authorized. ! 7. That if future operations by the State of New York require an alteration inI the position of the structure or work herein authorized, or if, iff the opinion ofI the Department oJ Environmental Conservation it shall cause unreasonable ol~structlon to the free navigation of said waters or flood,flaw',or eadanRer th,~ health, safety or welfare of the people of the State, or loss or destruction ofl the natural resou,ces of the State~ the owner may be ordered by the Depart° m~nl to remove or alter the structural work, obstructions, or hazards caused thereby wilhout expense to the State; and if, upon the expiration or revocation oflthis permit the structure, fill excavatlon~ or other modification of the wdtercourse hereby authorized shall not be completed, the owners shal, wiihout expense to the State, and to such extent and in such time and manner as, the Department of Environmental Conservation may require, remove all or an~ portion of the uncompleted structure or fill and restore to its former co~dition the navigable and flood capacity of the watercourse. No claim shall beJ made agaiosl the Slate of New York on account of any such removal or 9 [1-4 (9/75) (SEE REVERSE SLOE) 8. That the State of New York shall in no case be liable for any damage or injury to the structure or work herein authorized which may be caused by or compensation shall accrue from any such damage. 9. That if the display of lights and signals on any work hereby authorized is not otherwise provided for by law~ such lights and signals as may be pre- scribed by the United 5tales Coast Guard shall be installed and maintained 10. All work carried out under this permit shall be performed in accor- dance with established engineering practice and in a workmanlike manner. 11. If granted under Articles 24 or 25, the Department reserves the right be just and equitable. If upon the expiration or revocation of this permil, the modification of the wetland hereby authorized has not been completed, the site to its former condition. No claim shall be made against the State of New 12. This permit shall not be construed as conveying to the applicaut any right to trespass upon the lands or interfere with the riparian rights of others to perform the permitted woik m as authorizing the impairment of any rights, title or Interest in real or personal property held or vested in a person not a 13. The permJttee ~s responsible f~ obtaining any other permit% ap- provals, lands, easemonls and rights-of-way which may be required for this project. 14. If granted under Article 36, this permil Is granted solely on the basis of the requirements of Article 36 of the Environmeutal Conservation Law and Pqft 500 of 6 NYCRR (Construction in Flood Plain Areas having Special Flood Hazards - Building Permits) and in no way signifies that the project will be free frbm flooding. is con,agent upon strict compliance with the special conditions on the DE, SCRIPTION OF PR~JEC,T cont.) approximately 50' south of Marion Lake. Sanitary systems for three northerly lots will be located between houses and Rabbit Lane approximately 125' south o Marion Lake and 150' landward of mean high water. Approximately 500 cubic yards of clean fill will be trucked in for the sanitary systems and are to be p~aced within 15' of th~ base of three houses on the northerly lots. SPECIAL CONDITIONS 1. There shall be no disturbance to the vegetation or topography within 35': of Marion Lake.i 2. Ecu~ the three houses on Marion Lake, not more than twenty percent (20%) of the lot area cani be co'.vered by impervious surfaces. 3. All, construction must meet local and Federal flood plain ordinances. SPECIAL CONDITIONS A TtROUfH{ J ATTACHED. SPECIAL CONDITION M ATTACHED. PERMIT SSUE DATE PERMIT AD~AINISTRATOR ~J.~:~.z. zza.~,l ,, JADDRESS 11794 iAppllcation Received Disapproval Issued 19 m$ FORM NO. 10 APPLICATION FOR DEVELOPMENT PERMIT In the Town of Southold Type of Development Proposed: Addition and/or Alteration[] Other (specify) ...... New Structure (including storage tanks~ Flood. Proof Below Base ~lood Elevation~ Elevation Data in relation to above mean sea level of: (a) Lowest floor elevation, including basement ~72_ ,fOO~ .3 ~inches (b) In a V Zone, bottom of lowest structural member .. i~" inches FIRM--Flood Insuranco Rato Map, Zone designations ~-7 ~e~t~,c~_) Owner of Promises Location of Property: Block , / Z_ Lot(s) County Tax Map No., District, 1000, Section ~/ Subdivision. .. _ ~ 'Filed Map .P~e~rmission to. be ~r~a~nted: nor as abdve New O~er [ [Unde~ Contract~ ~ Lessee ( ~ oontracto~ Per~nit~ is issued: WmL^NDS ZBA ?q/~ : PL^NNEG BOARD Approval from other(s) before DEC /o/ ifF'y-".... nEST'S SERV OE, F,? $o - BUILDING PERMI~ /g~D'~ Z, O~e~, New O~orl--~, Onde~ Oon~act~, Lessee~, Agent]~, Oon- tract0~, and agr~ to comply wmth all applicabi~ s?ctions of the Code of the To~ of Southold; Cowry, and State ~d to a~zt authorized in- specters to premises authorized to perfo~ o~ have performed the said work ~d to make and file this application, that all statements contain- ed tn this application are true to the best of my.knoHledge and belief and that the work will be perfo~ed in the' maHnerset fG~th in the application filed therewith. STATE OF N~ ~YORK, / COUNTY OF~~S SWORN TO TtlIS [[ DAY OF ~ i9F~ uazN[,Z~ , NO, 4707878. Suffolk ~n~ '- Notary Public .... Applicant,s mailing address and phone # if not given above: 4/8o P.O. BOX ?28 SOUTHOLD, NY 11971 FORM NO. ~0 TOWN OF SOUTHOLD BUILDING DEPARTMENT (516) 765.-1802 TOWN HALL MAIN ROAD 80UTROLD, NY A; B. C. :~ '"' AP}LICAT,aON FOR DEVELOPMENT PERMIT ...... Instructions: The application to the Building Inspector includes (each ~'"'ddpli6at-g) 1. Form No. 10 filled out in ink or typewritten, 2. Sur-' vey of premises with elevations above mean sea level, 3. Drawings of pro- posed work. The application must give complete information to show' that ~ the proposed can comp%y to the Local Law No. 1-1980, Chapter 46 of'the Code of the Town of S~uthold known as "Flood Damage Prevention Law" of the. Town of Southold. The applicant must submit approvals that any.otheP agency requires. ~ General S'tandards as ~equired in Section 46-17 of the law to minimize flood Anchoring of ~tructures, including tanks and mobile homes Use of construction material and methods t5 Design and location of utilities Subdivision p~oposal with drainage, public utilities design and base flood elevations S_~$ci~ic Standards asirequi~ed in Section~46-18r ~ A~ Residential censtruction ' B; Non-rgsidenti~l construction C. Mobile homes The aPplicAnt must suWmtt plans and specifications as well as any other information requested iby the Building Inspector to substantiate the facts that the structure has or will have the lowest floor, including basement/ cellar, elevated above the base flood elevation or; if permitted by the Federal Regulation, that: 1. such structure is flood proofed in such manner that below the ibase flood level the structure is water tight with walls.substantially and impermeable to the passage of water, 2. that structural componentsiare capable to resisting hydrostatic and hydrodynamic loads and effects of buoyancy, 3. applicant must sub, it certification by a registered professional engineer or architect that the standards set forth in Section 46-18B (1) (2) (3) of ~the Southold Code are satisfied. Coastal High Hazzard 'rea V Zo . -- .. . . ~ -- ( ne) 46 19. Applicant shall submit plans, ~pecm{~cations includii~g the required certifications and such other in- ~r~on as t~? ~uil~mng Inspector may require in that ~he provisions of ~o,z¥ are comp±me~ with. Mobile homes are prohibited. The lowest portion Of the structural members of the lowest floo~ cannot be lower than the base flood elevation ~ith all space mbelow open except breskaway walls. Sand dunes. If sand dunes exist on the premises and the applicant pro- p'~ses %o alter same, plans and specification must be shown in detailed nature of any alteration submitted. Buildin~ Permit. A BGilding Permit is also required for any structure. ~th a ~evelopment and a Building Permit must be issued before any work can start in a specta~ flood hazzard zone. A, writte~ disapproval or a permit must be issued iwithin ton (lC) working days. Dubtng construction, tlhe inspector Shall be notified in time so he may make the required insplections. Upon 9omplction, the ~equlred certification fo the final elevations and wor~"~uut be subR~tte~ before the approval to use or occupy can be 'approved. , 4/80 (Fill out the form on the back of this sheet) 'FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 ×amined. .... 1 . 5-..permit ..... Disapproved a/c.. ............................... ............ ........... -::: ...... APPLICATION FOR BUILDING PERMIT Received ..... ,19 INSTRUCTIONS . I a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with ~ets of plans, accurate plot plan to scale. Fee according to schedule. ib. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets r areas, and giving a detailed description of layout of properW 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 BuildingPermit. [ d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit ~hall be kept on the premises available for inspection throughout the work. i e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy ~ ~hall have been granted by the Building Inspector. I 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 constr~cfion of buildings, additions or alterations, or for removal or demolifion, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to ~lmit authorized inspectors on premises and in building for necessary inspections. The Devin Group, Ltd (Signature of applicant, or name, if a corporation) Box 106, Southold, NY 11971 (Mailing address of applicant) gtate whether applicant is owner, lessee, a~ent, architect, en~neer, general contractor, electrician, plumber or builder. )wner ' · , '~ Xlame of owner of premises The Dev,in Group~ Ltd. (as on the tax roll or latest deed), If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No...Self ....... "' ' ' ~i,;,' ' Plumber'sLice/aseNo...-~.~...~..'. ~.[.~.?.'...~.. Electrician's License No.. !~ .................... Other Trade's License No ...................... · 1. Location of land on which proposed work will be done..R..a.b.b.i.t...L.a.n.e.:..E.a.s..t..M.a.r..]..o.n.,... %7:-.9. ...... 235 Rabbit Lane East Marion House Number Street Hamlet County Tax Map No. 1000 Section .... Q.3.1 ........... Block .1.7 ................ Lot ...... 9. ............ Filed Map No ............... Lot ............... Subdivision ................ (~q'a~) ................ State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy Singl9 Far0!l~ Building Lot ~- ~. ~ .,, ~ . b. Intended use and occupancy .... F.~ .I~e~J,cle~.~ ............... ~, ............. :~ .............. 3. Nature of work (check which applicable): New Building ...X .' ..... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... , (Description) oO, z7o 4. Estimated Cost . $45~.0 ...... : Fee ,! ~ (to be paid on filing this application) 5. If dwelling, number of dwelling· un, ts 1 Number of dwelling units on each floor If garage, number of cars ......................................................................... 6 If business commercial or mixed occupahcy specify nature and extent of each type of use 7 Dimensions of ' ' ' if any: Front Rear Depth · existing structures, ............................................ ~Height Number of Stories Dimensions of same structure With alterations or additions: Front ................. Rear .................. Depth' Height Number of Stories · 2 ' .s.,: ..... ..'' .5". .... 8. Dimensions of entire new construction: Front .... 5.. Rear ....... ' .....Depth .. .. Height ...3.0.' .......... Number of Stohes ......... .2.... ............. 9. Size oflot: Front 83' ... Rear 100' Depth .12~./17.5.: 10. Date of Purchase AU.~tCs. g J. 9.85 Name of Former Owner J.~.c.k. 11 Zone or use district in which premises are situated ..... Res±dent:£al . 12..Does Pr9Posed construction wolate any zoning law, ordinance or regulation: . ?.9 ............................ 13. Will lot be regraded ........ i.., ................. Will excess fill be removed from~ premises: Yes o ) 14. NameofOwnerofpremises .D?.¥.~.n. Group Box 106 . ............. Address ................... rnone No..-..:..-. ~.; ~. .. Name of Architect ...... i Addr Ph · . .~ .................. ess ................... one No ................ Nam of Co tractor ' Address Phone No'7.~'. PLOT DIAGRAM Locate clearly and distinctly a~l buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block nomber or description according to deed and show street names and indicate whether interior or}cornerlot, t i t . ./ i STATE OF NEW YORK, t} ~ ~l COUNTY OF ............. t~[ S.S ........ ..... T.?.d. ?.o..w.d ........................... being duly sworn, deposes and says J applicant I (Name of individual si ning contract) above named. He is the ......................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dgly authorized to perform or have performed the said work and to make and fil~'this- application;that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the mantlet set forth in the application filed therewith. Sworn to before me this ~ , .............. ]..~..~. ....day~f .... ~ ....... 19 .~r~-ff - ~ NotaryPublic,.....'~.'.. ~.'..~..c(.~..~.~....'.. Count~ ~ ~ELEN K. [~[ ¥OE : ' ~ PUItL C, 8tare of New ~ ' ' ' ~ ~;~'/0~''~, S,'~**!k Co~nll~, (Signature of applicant), ~;~: ~T' - ...... ' ~- LICENSED LAND SURVEYORS g'; " :{ GREENPORT NEW YORK _,, SUFFOLK'] SERVICi CONSTRb DATE: H. S. REF-. APPROV~ SUFFOi DIST. OWNERS ' .. Tie DEED: L,~ tESt H ? VAN TUYL VEYORS GREENPORT NEW YORK CO. HEALTH DEPt. APPROVAL H.S. NO. i STATEMENT OF INTENT E' WATER SUPPLY AND SEW'AGE DISPOSAl sYsTEMS FOR THIS RES!DENCE Will CONFORM Of ' Hi, alt ' · SUFFOLK COUNTY SERvIcEs -- FOR CONSTRUCTION ONLY DATE. H. S. REF. NO.: APPROVED: DEPT, Of 'HE~LTJ't~ APPROVAL OF SUFFOLK CO.:TAX DIST. SECT. DEED: L.~l~9 TEST HOLE SEAL t i sUFFOLK H.D. REF. T~,IcK VAN TUYL, P.C.' klCEI~D LAND SURVEYORS GRE~ENPORT NEW YORK SUFFOLK CO' HEALTH DEp~i~PPRo~AL H S, NO~ HEALTH DEPARTMEN1 ,W~J.,NG ONLY 1~:'~ OF INTENT {si · . OF ,-~r--H~A f..~H"SE R V ICES. SUFFOLK COUNTY DEPT. OF HEALTaH SERVICES - FOR APPROVAL OF CONSTRUCTION ONLY DATE: N. S. REF. NO.: ~"~- APPROVED: SUFFOLK CO. TAX MAP DESIGNATION: DIST. SECT. BLOCK PCL iOC~D, O~l l '7 9 OWNERS ADDRESS: ~Ol '1~+-/'''' ~ ~'. TEST HOLE STAMP Guam~ Imlle~l hm'~ MIMh OCCUPANCY OR ' USEIS UNLAWFUL V~ITH~tJl CERTIFICATE 'OF OCCUPANCY Pho:~e 477-0400 ~l~in ~oad GREENPORT N Y. 11944 :t t Pho~ae 477-0400 '0 Mii~ii Road