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Home My WebLink About24499-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-25954 Date: 09/08/98 THIS CERTIFIES that the building ACCESSORY Location of Property: 460 PADDOCK WAY MATTITUCK (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 107 Block 4 Lot 2.11 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 8, 1997 pursuant to which Building Permit No. 24499-Z dated NOVEMBER 19, 1997 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 INGROUND SWIMMMING POOL WITH FENCE ENCLOSURE AS APPLIED FOR. The certificate is issued to ALLAN & CHARLOTTE DICKERSON (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 19351 12/17/97 PLUMBERS CERTIFICATION DATED N/A /71ld i Inspector Rev. 1/81 FORM NO.$ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD,N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) DatNOVEMBER 19 97 Date...... 24499 .................. ........... . .................... . 19........... Permission is hereby granted to: SWIM KING POOLS(DICKERSON) .......................................................................I.................. 471 RT. 25A ...................................................................................I...... ROCKY POINT,NY 11778 ......................................................................................... to.., CONSTRUCT AN INGROUND SWIMMING POOL WITH FENCE ENCLOSURE TO CODE AS APPLIED FOR ....................................................................................................................................................I............. .............................................................................................................................I............................. .................................................. .................................................... ............ .......................................... ........................................................:............................................................................................... 460 PADDOCK WAY MATTITUCK atpromises located at.................................. ............................................................................................ ................................................................................................................................................................ County Tax Ma No. 473889 0004 002.011 ty p Section ........................ Block ........................ Lot No. ........................ pursuant to application dated OCTOBER e .......................................................... 19......97...., and approved by the Building Inspector. 150.00 Fee$........I................ .. "'` 'l. ............................... Building Inspector Rev. 6/30/80 Form No. 6 A06 TOWN OF SOUTHOLE j BUILDING DEPARMNt TOWN HALL 765-1802 {i( 21 APPLICATION FOR CERTIFICATE OF OCCUPANCY A. This application must be filled in by typewriter OR ink and submitted to the buildint inspector with the following: for new building 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 from Health Dept. of water supply and sewerage-disposal(S-9 form) 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildir and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings an pre-existing land uses: 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool -t23- 001 Accessory building $25.00, Additions to accessory building $25.00. Businesses--- $50.00. 2. Certificate of Occupancy on Pre-existing; Buildine - $100.00 3. Copy of Certificate of Occupancy 4. Updated Certificate of Occupancy - $50.00 5. m orary Certif cate of Occupancy - Residential $15.00, Commercial $15.00 RV VW1 + Date . . .�!�a. .��qti. . . . . . . . . . . . . . . . . . . . yi . . . Old Or Pre-existing Bt1u ld g. . . . . . . . . . . . New Construction. 4Location of Property. . . .4.k.. .. . . . . ... . .. .. ./e:Gl House No. I' Street ` Hamlet Onwer or Owners of Property.. . .�.�.41:e�S :�! , , , , , A,V County Tax Map No 1000, Section. . .j � . . . . ..Block. .. . .. ;';t. . . . . . . . .Lot. 9:J I. . . . . : . . . . . . . . C�.. . . .Filed Map.. . . . . . .Lot. (z. . . . . . . . . . . 4. GG X , i t. . . �AlwPermit No. ,Date Of Permit. . .! . �. q.7. .Applicant. . 10C 1 Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . .. . .Underwriters Approval. .,? . . . . . . . . . . . . . . . . . . Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. .X. . . . . . . •��O G Fee Submitted: $. . . . . . . . . . . . . . . . . . . . . . . _ 6 (..�. 1..�.� �'>.... . . . . . . . . . . . . . . ��Qrt�,S�j l APPLICANT Cas95y ELECTRICAL INSPECTION SERVICE INC. 375 DUATONAVENUE EAST PATCHOGUE,NEW YORK 11772 (516)286-6642 19351 DATE: 12117197 APPLICATIONNo.ONFILE VILLAGE: Mattituck TOWN: Southold ADDRESS: 460 Padlock Way ISSUED TO: Dickerson INTRODUCEDBy, Hank's Electric Inc. LICN« 2675E was examined on 12117197 and found to be in compliance with the National Electrical Code LOCATION: Base.. xz 1st 2nd 3rd Attic Det.Garage Hot Tub Pool xx SWITCHES RECEPTACLES FIXTURES HEATERS FANS G.F.I. AIR COND. 2 2 1 DISHWASHER DRYER CLOTHES WASH. GAR.DISP. RANGE OVEN SMOKEDETECTOR FURNACE OIL GAS CIR. MOTORS BELL TRAN SERVICEDISCONNECT METER AMPS PHASE OTHER EQUIPMENT 1-500 watt light 1-20Amp. time clock 1-20Amp. spec. .1-pool heater OOL NO VISUAL . DEFECT'S 4- - S. SURDI PRESIDENT BUILDING PERMIT No. This certificate must not be altered m any manmr Inspectors may be identified by their credentials BLUE ORIGINAL YELLOW COPY PINK COPY OFFICE ass-isa2 suaniNa DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION I 1 FRAMING [ v]'FINAL �1 [ ] FIREPLACE & CHIMNEY REMARKS: DATE INSPECTOR suauINa oar. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] 71NAL S CATION 1 FRAMING [ L /i'l�-�) t [ ] FIREPLACE & CHIMNEY REMARKS: :zL ��h- • �� DATE B �8 8 -INSPECTOR _�% i' t_ t:t.i, i; ia:i i utt nr ruu r nn�rt UUM flIII IMATIIII I ( 1!;'i.) ....... M t !;Ut►III►n'I'IUhI (2fIU) _ — ----- - { nitur.tt 1'i.11tllt I ril: Q r ----------------------- I Il:;ill.n'f I till !t'I n'T R 1,111!111!Y I,DIIR A 14 {. r I nnl. • ------------------------- -------- --------------------- -------- _--^ _ __.—_...�... _ ..•__ ......_►...._„ nlllt 1'i'1 Ottnl.�(:(tf till;ll'1'lt.....—..._._..................___.........._.... - I • �i S p \rte 11 1'1 BOARD OF HEALTH . . . . . . �,.... 3 SETS OF PLANS . . . . . . . �+ FORM NO. 1 SURVEY . . . . . . . . . . TOWN OF SOUTHOLD CHECK . . . . . . . . . . BUILDING DEPARTMENT SEPTIC FORM R TOWN HALL NOTIFY SOUTHOLD, N.Y. 11971 CALL TEL.: 765-1802 MAIL T0 :• • • • . . . . . . Examined . . . Approved . . . .11111 . . . . ., 19/./Permit No. .° . . .9. . . . Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . ld' g Inspector) APPLICATIO OR BUILDING PERMIT O� Ob : 47 Date . . . . . . . . . . . . . . . . . .. 19 INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted 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 issued a Building Permit to the applicant. Such permit shall be kept on thepremises available for inspection throughout the work. e. hTo1 GMAWupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall havOtaiWAO®119940ftilding Inspector. Its M!0►'Mi APPLI BY 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, buildin e, housing code d regulations, and to admit authorized inspectors on premises and in building for necessary insp ns. i nature scant, or name, if a corporation) ss of applic WMW6ffft% * MtJMW 1/o, State whetherJ appagrt is ciWiler,�l$essee, agent, architect e�name` � ectrician, plumber or builder. w � . . . . . . . . . . . t. . . . ... ... . . �w�r�w�t . . . . . . . . . . . . . . . . . . . . . . . . . . Cha. loc all r Name'.c6rowr}er�of premises .1�4�?. . �. . r MM 4. . . . . . . . . . . . . . . . . . . . . . . . arte �d� If applicant is a corporation, signature of duly authorize IM J.IA Y.N !IR �Hr . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .rr111111110 is IINI009M PATR (Name and title of corporate officer) AAiwalwo 1OM .a3g0, ALL CONTRACTOR'S MU T B SUFFOLK CO Na'J 40 MOtS1^ Builder's License No. . . . 4./. . . .H.1. . . . . . . . Plumber's License No. . . . . . . . . . . . . . . . . . . . . . . . . - Electrician's License No. ° 6.75 . E. . . . . . . . . . Other Trade's License No. . . . . . . . . . . . . . . . . . . . . . 1. Location of land on which proposed work will be done. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 460 . . . . . . . . . . . . Padlock . .W4,y . . . . . . . . . . . . . . . . . .A �: ae* . . . . . . . . . . . . . . . . . . . . .- House Number /Street Hamlet i County Tax Map No. 1000 Section . . !D .r . . . . . . . . . . . Block . . . . . . . . . . . . . . . Lot . '. . . . . . . . . . • . . . Subdivision . . . . . . . . . . . . . . . . . . . . . . . . Filed Map No. . . . . . . . . . . . . . . Lot . . . . . . . . . . . . . . . (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . . . . . .Family-DwP Il in . -f rn ake b. Intended use and occupancy �`/ . . ..U. . m�u. . . .. . . . . In 110-h 4 ' -Fwce- -fD code, 3. Nature of work (check which applicable): New Building . . . . ... . . . . Addition . . . . . . . . . . Alteration . . . . . . . . . . Repair . . . . . . . . . . . . . . Removal . . . . . 8 . . . . . . . . Demolition . . . . . . . . . . Other Work .PQ().). . . . . . . . . (Description) 4. Estimated Cost . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . t ` `to be paid on filing this application) 5. If dwelling,number of dwelling units . . . . . . . . . . . . . . . Number of dwellin ch floor . If garage,number of cars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. If business, commercial or mixed occupancy, specify nature and extent of each type o u '. 7. Dimensions of existing structures,if any: Front . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . Height . . . . . . . . . . . . . . . Number ofStories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dimensions-of same structure with alterations or additions: Front . . . . . . . . . . . . . . . . . Rear . . Depth . . . . . . . . . . . . . . . . . . . . . . Height . . . . . . . . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . . . . —S. Dimensions of entire new construction: Front . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . Height Number of Stories . ' b 9. Size of lot: Front . . �-Or.�. . . . . . . . . . . . . . . Rear . . P:L��. . . . . . . . . . . . . . . .Depth . 4!-i13* . . . . . . . . . . . . . 10. Date of Purchase . . . . . . . . . . . . . . . . . . . Name of Former Owner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. Zone or use district in which premises are situated . . 12. Does proposed construction violate any zoning law, ordinance or regulation: No . 13. Will lot be regraded ... . . . . . . . . . . . . . . . . . Will excess fill be removed from premises: Yes No 14. Name of Owner of p emisesAlla+►1,Charlo#a Diakeewn Address AM POdd"k "Y Y. Phone No. QQ37 456. Name of Architect Pte, ,qe. Mlie 0,5 AddressLAn�low !Ad,Dorf Jeff Phone No. 9a8;8x37 Name of Contractor s 1. 2oclecks,^. . . . . . . . . . . Address 17; kt, a5�4,.. .y pbin+ , Phone No. .?`f` -$!� . . . . . 15. Is this property located within 300 feet of a tidal wetland? *Yes . . . . . No . . . . . *If yes, Southold Town Trustees Permit LOY be required. AM Locate clearly and distinctly all 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. Ln' � "ljNp,,pMjR��c UPON MR help-, UNDERWRITERS CERTIFICATE • REQUIRED AV 7�i�1�0te4 m m M ' , --- mom OCCUPANCY OR wMrrvw• _ USE IS UNLAWFUL " WITHOUT C 4. re" , CERTIFICATE .� �� r>r� OF OCCUPANCY AM COI�M1 V "a Me�Mn* o0". Nor F DEEM CM STATE OF NEWORK S.S COUNTY OF . . . a pedt k,. . . {��nIt A&� . . . . . . . . . . . being duly sworn, deposes and says that he is the applicant (Name o�f�ndividual signing contract) above named. p He is the . . . . . . . . . . . . . . . . . . . . . . . . . . . .�,d n�:r�LGTt?� . . . . . . . . . . . . . . . . . . . . . . (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file 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 manner set forth in the application filed therewith. Sworn to before me this . .day of. . . . . . . . . . . . . .. 19 q� Notary Public. . . . . . . . . . . . . . .. . . . . County H eci in t.n,�s t . . . . . !/. : . . . . . . . . . . . . . . . . . �nmissionxpirea�I�gp (Signature of applicant) `A 34121' .301.Ox• Lot 9 O - k. G ' f % 6 . 3 OSS?F Q� Q 8 'b •• �sso pg00�` ��` ° � Is 4: ljr � 4s� O 2"•� .'� � Lot 1 o o Lot 10 h co %0 h N I "IMMEDIATELY" s N maII SE POOL m CODE 4� ate► °) O r UPON COMPLETION 661 N z .BEFORE"WATER" ppM ' 1 N ' Vyt 'CRt =of I _ 1 , o O pie�.ti� _ R+ 13 0 38 p "E• `'E�t a =3j�o°O' O N-79058,06?9 206.78 D cp 1 o�Rs + �'� <A3i°o J � Z C � r d 1 / / yt�l•iC � / v J _ "� 81tNaFQ A1Y 011-Y Wain R 1o' d► N o n a -�P a' f �''•1 h:1V�I lMG ' �IdlOI V1 vvat 1w,AirY o o :?► �101�• • :;�•: tall OI gytlK NgMMjM . �W be 4 • CIO 4 Lo t •� s; Areo =50544 AC. �o P.E..C1 . ' as •/h phaAsCONN' pftN of=led 4 c, �/ ►6i 120.4' • 298.19 '� LAND 006.3 W. 1 R�wsloNs YOUNG ,& YOUNG" g.83 Nerr 1 for_"QA ' p� LputS T , noM1 or T SEPT. 14,t994 400 OSTRANDER AVENUE. RIVERHEAD, NEW YORK E F • OCT. 4,1994 IIEALTH DEPARTMENT -CA TA FOR APPROVAL i0 CONSTRUCT Dean �1IIEDIA LY"' SEPT. -0 1995 AL.DEN W. YOUNG HOWARD W. YOUNG 41-NEAREST waTEP MAIN_M tSOURCE �'F WA'ER PRIVATE_PUBLK_ ' EPOOL710 ` JUNE 17,1996 F'ROFEflIONAC 164, ER AND I LAND SURVEYOR • SU9F CO TAX MAP DIST—SEC,T-ON 107 BLOCK 4 LOT d � , 'MIN :•t LANA SURVEYOR. N.Y.S. LIC NO, 12845 N.7.f LIC.NO.AOKI' f 'MfRE• ARE NO DWELLINGS WIrMIN 100 FEET OF THIS PROPERtr _ BEFORE• ~ _ __ ; SURVFY FOR. OTHER THAN THOSE SHOWN •IEPEOts. 711AUTN0RI[EZ AtrERATICu1 IR ADD+T•l]N r. R rHE WATER SUPPLTAND SEWAGE DISPOSAL SYSTEM FOR rHIS RESIDENCE THIS SuR✓EY ,5 A �ICi•TtON :+ TEL116N ALLAN DICKERSON & CHARLOTTE DICKERSON w1LLCONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY DEPART ME NT 7205 OF •wE Yt• -ORI( STAGE F3✓CA:7CN OF HEALTH SERVICES. LOT N0. 12,' "WOLF PITPOND ESTATES, .. APPLICANT _• ' COPIES AF THIS SVNVEt' OAF NC' BFAWNS . "•1E LAND AOR✓E 0WS INKED SEA: 011 . ADDRESS EWOSSEL SEAL SHAEC N{.T Of G:•NWOEREO TO RE A v'ALID TRUE COPT. AT ca"r EO TO$ •r, T' MATT I TdC K aacEiaoN F TEL � .. _ _ ____ _._—_ `�t S4AIVANTEES':NDICATEJ r1ERCON SMALi 4W1 LMS -+--:.---- - _- - _- ----- aILY to rot rERSGw FCO WHOM -HE TOWN O¢' .,: c.. NOTE:N s MONUMENT FOUND �s STAKE FOUND *11NET 1s PnEPAREO AND R Nts sE11A f HOLD r =, ' �p )• :c IVISION YAP FILED IN THE OFFICEOFTHE CLERK OF E Comm "%.tlr� yloY.sovtRNrENrAI -•r." , " ``'` ° '` 'g St�FFOL1; CaMTY ON JUNE 21:,0990 A8 PILE: NO.S"& • �. - two11'a"fir ¢fir, r - f irbTron Llnco �` ' w •�• *�++' r`iF. 't..•; '�'.,;:x�e4. _ - .;ri I •::. :• ♦• �•TNE• ISM�EO EI THE 1 _ .]r �.� a ,� �. 4- --r .• .L'. #S. LL t1TLttOM: SUAl1ANTCR - -- �P T OISIC>•)110M1N HEREON K[-TO 40IT104i!t STM[ �+FEiLt1M1.iIM •i . Fr "' :, .• ,rst ow w [b1tit1 '� _ AREF - ,,. �' *` `' a ' -"."� `!-Lt"-. ..;, :"'!v .' •� s ;SIF"-. .-s• 'j? •'1 e' •. �' `L. - -K — p _ yy--aa Q'.a.,i•,'�. t"::F�, r� - t ,,,1, _ F n .V..0"r.. - tS•T ,"„ - ,ti, _'"R.. s - ... q� r. e VINYL LIt1EP - 't``o�•t"t �' SKIMMER --- � RETURN -9 3 - 3/g� BARS FORM TIES 211 8'R j 'p TO FILTER - - �- •X 1("R ! -�"� �� FROM SKIMMERS q'R " , ROLLED FOAM 0 /OPTIONAL STEPS BETWEEN LINEFZ-. FILTERond PUMP 8'R 2'R 8'R ,� r CONCRETE FROM FILTER 35001b TO RETURNS --- TO WASTE POURED CONCRETE VINYL LINER-'*-, 6 -0 PIPING ARRANGEMENT PLAN �,; w;.� e• f-- s', 16"topic 2: 4' SAND 10~ eC2)altRs SECTION '� I 1 SEE TYPICAL WALL S ECTION I FORM TIE i FIBERGLASS MOULDED m I PIECE 2 4 MAX 3/g' BARS O 2�- 4'SAND BOTTOM v •� —� 13 g'- 0* 13' SECTION B— B PLAN OPTIONAL STEP GRADE TYPE 1. TYPICAL WALL - ' G �o SECTION A- A NOTES: PROPOSED POOL FOR: CONTRACTOR: WALKS TO BE SMOOTH, NON-SKID TYPE SLOPED AWAY FROM POOL. RANDY T. RODECKER, INC. WATER DISPOSAL SHALL BE LIMITED TO SWIM KING POOLS 214 OWNERS PROPERTY TO SUIT LOCAL REGULATIONS. ROUTE 25A, ROCKY POINT, NY 11778 {, 541.21• Lot 9 rL:301.OxQ �• 6K,, ss; 41 _ r ; i I e- • � _Ot o N Lot 10 apO O �. ,ol N aJ N C 'IMMEDIATELY" N cd o rn NOOLW CODE 681 q3 Q�a PLt1m z "YIMCIl01" fly . c CtFt -; O coz R. pit t -APO O.1pz�� \ a tolRa 9, % Apo fn p 20• • of a I 1 1 Q bP iLAJ 1 MESSRSJ . W 2 �Vqn �+ < 2 „� �; Y H.S.FMt.N��.� ••-� \>1 ' 9 sj1*,.f!t^ta' ♦1� or„t• U/ v a+ N vp Ot oEMr A W o . g ?r'� i >1r iG1� t0 aAill y�► �4 z �•�� o Lot 12 �'��o° y - _,�-� r� . C.�� .«• ` a ! _ p 0 =5-05 44 A pl-M A.COsatF P.E•.U M, C a r e ,�• pMlc`�d Wer Ilpd ww"wow45 \20.41' 29819 v ►e• .�, REv1sIONS YOUNG ,& YOUNG opg'3�w• S. T. Herr ' OvW or fOr rly SEPT. 14,1994 400 OSTRANDER AVENUE. RIVERHEAD, NEW YORK 7/{ Louis 1 n T UI 11 OCT. 4,1994 WIlR • � an F \ SEPT, -8,1995 ALDEN W. YOUNG NO W. YOUNG HEALTH DEPARTMENT -GA TA FOR APPROVAL TC CONSTRUCT De JUNE 17,1996 PROPESSIONAC KN61NEER AND LAND SURVEYOR LAND SURVEYOR.- Pd-Y-9- LIC NO, 12"13 N.11.S. LIC.NO,aOSIa 4-NEAREST NpTEP MAIN�M ± 11SOURCE C!F wA'ER PR!vaTE_PUBLK _ t ♦ SUFF 00 TAX MAP DIST 992—SECTION 107 BLOCK 4_LOT 2,11 SURV�Y FOR; . f '"FRE. ARE NO DWELLINGS WITHIN 100 FEET OF THIS PROPERTY -- _�'IJ�lALY". OTHER THAN THOSE SHOWN •IEPEON. �,� r'; niAu,Ha11zE: ALTE*•,l°N AUDIT-ON '` ALLAN OICKERSON CHARLOTTE OICKERSON THE WATER SUPPLTAND SEWAGE DISPOSAL SYSTEM FOR THIS RESIDENCE *0413 SjR,rtr ,5 a YK;LATION ;.r `A'."ON S.WIIICONfORM TO THE STANDARDS OF THE SUIrFOLK COUNTYDEPARTMENT 7209 OF •ME vt• +ORK STATE f0vCA•;CN LOT N0. 12t' ��WLF PIT POND ESTATES't Oc HEALTH SERVICES. BEFOREUMCOMRAIM ►w nW APPLICANT -` 1� COPIES uF TMIS SUMVE+' MAF !M' SFAF:N, -- --_'_ 'HE LAND S.%ROE'r�R'E INKkD SEAQ '20 ` EMFtOSSEL SEAS SHAD NUT tlt �:•NS'OEREn •r:, ADDRESS _. TO K A VALID TRUE COPY AT C .a MATTlTt K cE"A& To "• TEL ---• _-__-. _._,_ OWUTANTEE!'AI E3 HEREON $HALL RUN ` < �� E T1ML .X �. UMLT T° KRSGN iCR WHOM -HE TOWN O , .;:,.. ., MA`.r IBM _.,__:.__ T"[ '� HOLD =' x ��,, � `1, :;.,�,. 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