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Home My WebLink About13766-z FORM NO. 6 TOWN OF SOUTHOLD Building Department. Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in duplicate 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 featu res. 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 similar 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. B. 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. 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 Date ..... JgAff.$0~..~98A ..... New Building ... ~ ....... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ..... ~..~0~,, .Q~'~..~.~ aae~a t;e.. J{o~ ......... C~tt;.ch~l~,~e. .......... House No, Street Hamlet Owner or Owners of Property ..... ~. ~.c.h..a..r .Q..~r~.Q.e~.~q ~ .................................... County Tax Map No. 1000 Section .... ,~:[2. ....... Block ..... .'1~. ....... Lot .... ~.c) ......... Subdivision~e,e,~a,u, .I~oJ-.rtt;. ~z'.c~I~er,~.J.e ~ ...... Filed Map No .... .l.~0 .... Lot No. ~) .......... Permit No. ~1,3 7~..Z. Date of Permit .~/20~5.Applicant E r~!~;[~,.o~e.rtt .Ee. st,..[.rte ~..~.oz~. R. Health Dept. Approval . .. ~.. [J,S.O. ?P_ ......... Labor Dept. Approval ........................ Ander- sort Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate .... ~ .................. Fee Submitted $ ...... ~,.QO .................. ~ Construction on above described bui,ding a~~b.~c~d~s~' Applicany~_... ~..~-~._-- ..AD/. · and regu tations. FIELD INSPECTION COMMENTS FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY ~ODE FINA~.~ ADDITIONAL COMMENTS: P.O. BOX 728 TOWN HALL SOUTHOLD, NAt:. 1'.197[~ CERTI, F TEL: 765-I 802 that the solder: used iri Water supply system than 2,710 of 1% lead. [nature NEW YORK STATE DEPARTI~NT OF ENVIRONMENTAL CONSERVATION Bulldin$ 40, SU~--Room 219 Stony Brook, NY 11794 (516) 751-7900 A~ENDM~NT TO PERMIT EXTENSION OF EXPIRATION DATE Your recent request to extend the above permit has been reviewed pursuant ~o 6NYCRR, Part 621. It has been determined that there has not been a mater~l chan~e in environmental conditions~ relevant technolosy or applicable law or re§ul- ation~ since the issuance of the existin~ permit~ therefore, the expirat£on date is extended to I-2- ~ ~% ~ ~6. · This letter is an amendment to the original permit and as such, shall be attached ghereto, and a copy posted arlene.. lob site. All other terms and conditions remain as written in the original permit. Very truly yours, Regional Pd~n~t Administrator DJL:cz ~ ~t u! E NIW ¥~J~R %1^'11 I)1 PAfllMEN1 t)F iNVIIttINt, tl NIAI {'(INSI flV&lltIN PERMIT TW l a76-03 5) UNDER THE ENVIIIONMJ~NEAL CONSEIIVAIION LAW ARIICLI IS, fPnth,cIIoo ut W.lh'l) AH IlL L[ g~, (Ilddl Wellandb) AITIC~ ~4, (FllJhwater Welld~b) U ARIICL[ 36, (Con~l~uctien in flood flazald Areas) ~,~.uU~ gl~ner Olden Eot Josephine A. ~wi~ik and doAnn ~arte O~KeeEe P. O. ~x 38, ~in ~ad, Mattituck, New York 11952 ~p~x. 900' we$~ of ~nneweba Rd. on ~unnewata Pond and Channel. ~IIIPTION OF PPOIECT Co,natructton of one family d__w__el__l._ipg and associated sanitary system aboye ,,,~0' contour and c,one%ruct 16' right_R~ way. ~TY NAI~ (City, Tow. n, Vlilale) iU~y~*~I1~1' ]:)o.~.n'~ C~%chO~Be ~FiAC~MUNiTYNO~OwN Sou%hold , __folk . f GENERAL CONDITIONS The ~mlllee shal~ file In I~ office ~ the a~m~late ReRional T~ ~letll~ wk i~ll ~ ipbjecl Io Inspeclion by an authorized ~Mativl Ct t~ ~lt~nl ~ *Envigo~lal Consefvalmn who may Al a c~iti~ ~ I~ i6~uince of Ibis ~rmlt, the appliconl hes ex~esslf~ by I~ exec~lo~ Ct Ihe appUcall~, tile tull leRal Im all da~s~ direct m l~ifec4'ol whatever nalme, a~ by whom- s~ed, afiSinl oa ~ the pojecl deKri~ heleln aod has adreed to M l~fY ~m 4~ deicfl~l~ fesulilfll Ifom 1~ said ~ojecl. Any ~t~ial df~iod in I~ ~osec~lofl of I~ wink herein ~rmilted ~ g~ved ev~ly~ wil~ leavlnK larle ieluse pilesF fldKes acloss the I~ watelwiy m f~ ~aln m deep holes Ihal mdy have a te~eflcy to ~1 la MVI~k~Is a Io I~ hanks ~ I~ wale~Wdy. Thl il IMwe o~rallons by tM Slale al New Yo~k ~equi(e an alteration cli~ la tM Ime flaVlidliOn ~ said wale~s M I1~ flows .o~ e~dnse~ IPEI~IIT EXPIRATION DATE 8. Thai the State of New York shall In ftc case be liabqe for any damaRe or UIjul¥ lo lite structure or work herein authorized which may be caused by or 9. Thai il the displap of Ilehts and stRonls on any work hereby auth~Ized is not otherwise provided lot by law, such iiRhls and sijnals as m~y be pre. scribed by the United States Coast Guard shall be installed and maintained 10. All work carried out under Ibis permit shall be performed in accmo dance with e~labhshed endlneerinR practice and in a workmanlike manner, be tu~l ami equilable. It upon the espirallon or revocation oi Ih!s permit, )he ronmve all or any portion of Ihe uncompleted slructore or fill and restme Ihe lo. perlorm the permilled work o~ as auJhoriztn6 the impa,menl of any rIRhls~ I~. Thr pefmtllee is responsible f~' oblalOiOR any other permits, al~' pi'ovals, lands, easements dod rlMhtsmfoway which may be required for Ibis project, t4. It granled under Article 36, this permit I$ Ilranled solply oa the basis Part 500 of 6 NYCRR (Construction in FloOd Plain.Areas havln8 Special FloOd Hazards - BuildmK Permits) and in ftc way sljnifles thai lhe protect will be is conl!nl~ent upon strlcI compliance wilh the special conditiOOs on lbo feverse side. 4 (SEE nEVIEKSE SIDE~ 16)~ Applicamt ehall be liable for any damage to adjacent waterway reeultln~ f~ ~,mqf,phase.Df the pe~itted const~ction. ~7) ~'We' ~eee~e the risht t0 co~ent at a later date conce~ing other en~ ~n~ mspec~ of this project. ~8) The grating of this pe~it doe not relieve 'the pe~ttee of the .onsibility of obtaining ~Y pe~its, licenses, or other authorization ~ch ~Y be required by other State, Federal or local agenczes. .9) 'The ~ght of way or driveway will be const~cted of a pe~eable ~cture ~d be placed no closer than 20' south of 5' contour as per su~ey. ., The~e is %o be no disturb~ce of vegetation below 5' contour. C, Co Law Enforcement U.S. Ar~y Corps of Engineers File &~tachad~ Receipt No. U 21729 Southoid Town Board of Appeals APPEALS BOARD MEMBERS GERARD P. GOEHRINGER, CHAIRMAN CHARLES GRIGONIS, JR. SERGE OOYEN, JR. ROBERT J. DOUGLASS JOSEPH H. SAWICKI (~LDG, DEPT. TO~v'!~ OF SOUTHOLD November 18, 198§ Mr. Peter R. Stoutenburgh, Environment East, Inc. 3075 Indian Neck Lane Peconic, NY 11958 President ~e: Appeal no. 2760 - Richard Anderson Right-of-Way off W/s Wunneweta Road, Cutchogue Dear Peter: This letter will confirm that the following action was taken by the Board of Appeals at a Regular Meeting held last Thursday, November 14, 1985 concerning the above right-of-way: RESOLVED, that the improvements as inspected by the Chairman of recent date be and hereby are accepted, subject to the following requirements: l. That the improvements are to be within the legal peri- meter of the subject right-of-way; 2. That the right-of-way b'e continuously maintained at. all times in good condition. This resolution was unanimously adopted. Yours very truly, cc: Building Department/ GERARD P. GOEHRINGER CHAIRMAN By Linda Kowalski Buildtn§NEW YO~ 40,STATEs~--RoomDEPAR~ENT219OF ~IR()~NT~ CONSERVATION Stony Brook, NY 11794 (516) 751-7900 AME~)MENT TO PERMIT RE: Permit No. ~i.~mm 0 i~otlf~. Your recent request to modify the above permit has been reviewed pursuant to 6~CRR, Part 621. It has been determined that the proposed modifications will not substantially change the scope of the permitted actions or the existing permit conditions. Therefore, the permit is amended to authorize: ~is'~etter ts an amehdment to the o~tginal permit an~ such, shall be posted at the job site. All other terms and conditions remain as written in the original permit. Very truly yours, Daniel J. Larkfn Regional Permit Administrator DJL:cz APPEALS BOARD MEMBERS GERARD P. GOEHRINGER, CHAIRMAN CHARLES GRIGONIS, JR. SERGE DOYEN, JR. ROBERT J. DOUGLASS JOSEPH H. SAWICKI S uthold Town Board of Appeals MAIN ROAD- STATE EDAD 25 BDUTHI3LD, L.I., N.Y. 11g71 TELEPHONE (516) 765-1809 March ll, 1985 Mr. Peter R. Stoutenburg, President Environment East, Inc. RR #3 - 3075 Indian Nec~ Lane Peconic, NY 11958 Re: Appeai N~. 2760 Richard Anderson R-O.~W off W/s Wunneweta Road, Cutchogue Dear Peter: This letter will confirm that the board has unanimously agreed to authorize.a release of a building permit for a new one-family dwelling concerning premise~ along this right-of-way and owned.by Richard Anderson, the applicant, with the condi- tion that prior to an insulation and subsequent inspections, the right-of-way be improved according to the November 20, 1980 ZBA decision unde~ Appeal No. 27~0, and no further construction be done once the framing inspection has been approved. Please keep us advised accordingly in order arrange for a final inspection and acceptance of ments.to the right-of--w~y, and feel free to call if you have any questions. We are furnishing the Building this lette'r for their files. t' lk ~c: Building Department that we may the improve- at any time Department with a copy of Yours very truly, GERARD P. GOE~R~G~ CHAIRMAN ~ PERMIT SIGN PlO, ' ~A~ 152.,-~0353. issued to: *[ .r Gary, F!anner, Olsen for Josephine A. P;O. Box ~8, Maih'l}oad, l~tattituck, N. Y. 11952 Swit~ik and JoAnn M. !'Formerly 16' right of way. ~ the;~ Environmental: ConServation Law~ ii:~Article: 15;:i {proteCtionr :of water) : -- :'~;i:Article :: 24;'r (Freshwater Wetlandsli!i~ i Article 125 [Tidal', Wetlands) __ Construction ~., ~,,. of E~ir~nm~ntal Conservation;:?':- ,~ January 29, 198I Date Issued O'Keefe ~struct Environment East, Inc. R. R, No. 3 - 3075 Indian Neck Lane Peconic, New York 11958 516-7347474 29, ]92q 'iown of Soutb. o~d 'town *r~l Southo3c], N. ~ 3,1971 De ~ t. }{e: famderson, ~sssu Toist ~ ].dg. l-'ermit ~ 1376'~Z, Dated De~r Sir, Please be sdvised of m alter,-~tion to the plans now in your file on t~/e subject b~ilding permit. The enc]osed plans detail a revision ~,dding the former shed are~ to the original kitchen dimensions ~nd inc]udi~, s~e to the maim house structure. The pevision eefacts the kitchen ar~¢r~ snd the bethroom position to provide closet z~oola in the foyer area. These pirates ~:i]'~ be ~dopted to the presenL construction if a~- prove~ by your de~mtNent, · b~.s alterstion wss r~,,de st the owners request. ,, . ~ ./ be to thts'~Zce ~ soon ~s possible. 5.'~,vr~ks for your; co- onerat ~ ~ t:~e t e up~ ~ }? ~ P~3: jm Memorandum from . .: · BUILDING INSPECTORS OFFICE TOWN OF SOUTHOLD TOWN HALL, [lOX 728, SOUTHOLD, N.Y. 11971 765-1802 7GS-180~ BUILDING DEPT. INSPECTION [ ] F/OUNDATION ~.ST ~ [ ], ROUGH pLBG. [~/J"'FOUNDATION/ :~ND [ ] INSULATI°N [ ] FRAMING [ ] FINAL REMARKS, DATE INSPECTOR 765-180Z BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING RE;MARKS: ~.~ FINAL 76S-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION DATE ~INSPECTOR /~~ b THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~,1.t1~ .[:[, [~ 85 JOHN STREET, NEW YORK. NEW YORK 10038 THIS GERTIFIES THAT inthefollowlnglocation; ~] Basement [~ ,stFl. [~2,d Fl. Section Block Lot was examined on .JV~LI~ 0~ ~6 and found to be in compliance with the requirements of this Board. FIXTURE FIXTURES RANGES OVENS EXHAUST FANS OUTLETS SWITCHES INCANDE~CENTJ FLUO~SCEN~VAPOR 35 42 33 35 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIME CLOCKS MULTI-OUTLET SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT OTHER APPARATUS: ~an~Lbaard~t-lge~r.,2UO~mp~.~ £-~moke S E R V I C E OF CC' COND' OF HI LEG OF NEUTRAL · ~1~ 2/o Per certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their DEP ',~THR MANNER TOV~N OF SOUTHOLD, NEW YORK ACTION OF THE ZONING BOAI~D OF APPEALS Appe~No. 2760 Application Dated October 30, ACTION OF TI{E ZONING BOARD OF APPE~S OF THE TOWN OF SOUTHOLD To Sary []a~ner 0]sen, [sq. (for Richard A~derson Ma~n Road, 8ox 38 M~tt~tuck, NY ~]952 1980 AppeLant at a meeting of the Zoning Board of Appeals on N 0 V em b e r 20, 1980, was considered and the action indicated below was taken on your ( ) Request %or variance due to lack of access to property ( ) Request ~or a special exception under the Zoning Ordinance (X) Request for a variance to the Zoning Ordinance New York Town Law, Sec. 280-A ( ) the appeal ~anted ( ) be denied pursuant to ~ticle .................... Section .................... Subsection .................... paragraph .................... ef the Zoning Ordinance and He decision of the BuildMg I~peetor ( ) be reversed ( ) be co~irmedbecause Public Hearing 8:35 p.m. Application of Richard Anderson, by Gary Flanner 01sen, Esq., 8afn Road, 8attituck, NY ~or a Variance for approval of access pursuant to New York Town Law, Section 280-^. Location of property: Wunneweta Pond', Nassau Point, Cutchogue, NY; bounded north, west and south by Wunneweta Pond; east by O'Keefe. County Tax Map Item No. 1000-111-14-29. (SEE REVERSE SIDE) 2. VARIANCE, By resolution of the Board it was determined that (a) Strict application of the Ordinance (would) (would not) produce hardship because (SEE REVERSE SIDE) practical difficulties or unnecessary (b) The hardship created (is) (is not) unique and (would) (would not) be shared by all properties alike in the immediate vicinity of this property and in the same use district because (SEE REVERSE SIDE), (c) The variance (does) (does not) observe the spirit of the Ordinance and (would) change the character of the district because (SEE REVERSE SIDE) (would not) and therefore, it was further determined that the requested variance ( ) be granted ( ) be denied and that the previous decisions of the Building Inspector ( ) be confirmed ( ) be reversed. FORM ZB4 ZONING BOARD OF APPEALS After investigation and personal inspection, the Board finds as follows: Appellant has appealed to this Board seeking a variance per New York Town Law, Section 280-A for approval of access. The premises in question is located at the west end of a pennisula at Wunneweta Pond, Nassau Point, Cutchogue, New York and contains approximately 9/lOths of an acre. Applicant shows a 16' wide right-of-way from Wunneweta Road to the subject premises at the north end. The Board finds and determines that the relief requested in relation to the Code requirements is not substantial; that if the variance is granted no substantial detriment to adjoining properties will be created; that the interests of justice will be served by the granting of the relief requested; that no ad- verse effect is produced on available governmental facilities of any increased population; and that no substantial change will be produced in the character of the neighborhood. On motion by Mr. Douglass, seconded by Mr. Goehringer, it RESOLVED, that Richard Anderson, by Gary Flanner Olsen, Esq. be Granted a Variance to New York Town Law, Section 280A, for app~ of access, SUBJECT TO THE FOLLOWING REQUIREMENTS: 1. Such access road shall have a width of not less than 15 feet. 2. Such access road shall be cleared of all trees, brush and other obstructions to a width of 15 feet. 3. Such access road shall be improved in either of the following methods: ('a) Such access road shall be surfaced with a minimum depth of four inches of packed three-quarter-inch stone blend so as to afford access for emergency vehicles. Such stone blend may be either applied to the ground surface and shaped, or the surface may be excavated to permit the application of packed blend to a depth of four inches; or (b) The access road shall have top soil removed to a depth of eight inches and then filled with eight inches of a good grade stone and sand bank run. The surface shall then be covered with a layer of two inches to four inches of three-quarter inch stone blend; or in the alternative, oiled with a minimum of four-tenths of a gallon of road oil per square yard. 4. No building permit shall be issued for the construction of any buildings or structures on the premises to which this access is referred until all of the conditions set forth herein have been complied with. Location of property: Wunneweta Pond, Nassau Point, NY; bounded north, west and south by Wunneweta Pond, east County Tax Map Item No. 1000-111-14-29. Cutchogue, by O'Keefe. Vote of the Board: Ayes: Messrs. Douglass, Doyen, Goehringer, and Sawicki. Absent was: Mr. Grigonis. IVED AND FILED BY S "~ ~' TOWN CLES!~ OU ~**O~D Town Clerk, Town of ~olct APPROVED ~-~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y, 11971 TEL,: 765-1803 - 21985 ;xamined ................ ,19... kpproved ................ , 19... Permit No ............ )isapproved a/c ..................................... Received ........... ,19... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date. ~.a.n.u. ar3~..2. ...... ,19..$[~ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ts 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 ' areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- tion. 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 issued a Building Permit to the applicant. Such permit all 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 .all 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 ~ilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or ~gulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. he 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. E~Ay.i.~.Qr~e. qt.. ~].ast,. ~nc. ~q.a .agezat. £~. ...... (Signature of applicant, or name, if a corporation) Richard 5nderson (Mailing address of applicant) rate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....................................................................... ame of owner of premises R~_cha r,d Anderson (as on the tax roll or latest deed) (Na'fne and titie of corporate officer) Builder's License No...~7.~k...S.b.!.d.,.. 5555..J~I... Plumber's LicenseNo ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done ............................... .~ .................. ~Z 98 . .Wu.qrle~¢ ¢.t.~ a. Ro.a d. . .Cu ~; ch.ogue .................. House Nu,nber Street Hamlet County Tax Map No. 1000 Section . .11 1 ............. Block ...tlk ............. Lot .... .29 ............. Subdivision ).m.~ ~.dg.d..114.8p...5.. }j.a.s.~a. p..?.o.i.'9.t..P..rgpp~la-tat~ap No .~,$ ~ .......... Lot ... 2J~ ........ (Name) State existing use and occupancy of premises and inPe~ded use and occupancy of proposed construction: a. Existing use and occupancy ....... Va.c. ant ....................................................... b. Intended use and occupancy ..... ~,. ~:8.rl ~..] y..~e., ,~ i.d.q ¢9 P- .......................................... 3. Nature of work (check whidhial>plicable): New Building ...X ...... Addition .......... Alteration .......... Repair ..... ' ~' ' [t~ ' :R~moval .............. Demolition ............. Other Work ............... ....., : . i (Description) 4 Estimated Cost ' s 007 o00 Fe :¢' (to be paid on filing this application) $. If dwelling, number of dwallinglunits ............... Number of dwelling units on each floor ................ If garage number of cars ' 6. If business, commercial or mixe~d occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height Nuraber of Stories. Dimensions of same structure with alterations or additions: Front ................. Rear .................. Dept. .................. ;.. Height ..... ~:o.f ............. Nu~gr of Stories ........ ~., ........... 8. Dimensions of entire new c.onstruction Front .. ~?. .......... Rear . .'*. ............ Depth ............... Height ¢~ ~ ~ Number of Stori 2 9. ~izeoflot Front ~g~g, .1. a. gyp' . Rear ......... Depth ........ 10. Date of Purchase .SXq .0,/.8.1, ; ...... R' Ni~rOe o~For~ner Owner . .... ' · · os~aonv~a± ............................ 11. Zone or use district in wMch premises are situated .............................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ...N.0. .............. 13. Will lot be regraded ..Yea.. i ................... Will e-X6e~s ~fjll be removed from premises: ~" ~ 14. Name of Owner of premises ~J~ 9~%~.d..And. 9r.s.o.n.. Address~,~..~ :..3.0. i? .h..Ni¥' .N.l~hone No ...................~'-fff~.... Name of Architect . i . .. Address ..... Phone No. N/amc of Contractor ~nvironmen,t Y~ast, Inc a,1~,~oo307.~ ~[nd, i~k',' I.,n_p~nne No. ~/3l~-.7.1;7¢ ..... PLOT DIAGRAM Locate clearly and distinctly ali buildings, whether existing or proposed, and. indicate all set-back 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. STATE OF NEW YORK, S.S COUNTY OF ................. .......................... '. · .; .................... being duly sworn, deposes and says that he is the applicant (Name of individual sigmng contract) above named. He is the ..................... ~~ent corporate officer etc) of said owner or owners, and is dui authorized to perform or have performed the said work and to make and file this application; that all statements con tined 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 application filed therewith. Sworn to before me this ............. ~..~'-~. ....... day o ......... , 19 Nora .fy Public ....... ~..~.......~..~ ...... Coun H[LEN ~, DF. VOE NOIARY PUBLIC, State ol New, York .............. No. 4707878, Sulloik County SINGLE'FAMILY DWELLING ONLY APR 7: ,19,88 ,. ~. ~'. # ,[~'~.~,~ ,~ sewage disposal aud water supply for this loeattot~ have 3ected by this department ~d o be sattslfaeto~.O+~ ~ ~ dhief of General Engineerin~ ~.~ ..... ~ -~ ~ .... :1_ I I I . ! I t I %., N75564 SUFFOLK CO. HEALTH DEPT. APPROVAL LOT 2--% ~" ~A~ENT HTENT ~r --~ ~ C~FORM TO THE STANDARDS ~ THE, ~" ~FFOLK CO.-~PT. OF HEALTH ~ , Ap~iCANT ~ = SERVICES -- FOR APPROVAL OF J CONSTE~T~NON~~ . ' ' LICENSED LAND'mRvEy~ ~. ~AV~ GREEN~RT ~W YORK / / SCALE ", t LICENSED I SYSTEI~ CONFOF SUFFOL (S). SUFFOL SERVI CONSTI~ DATE: H. S. RE APPRO¥ SUFF, DIST. OWNER.~ 33~ DEED:L TEST t 4