HomeMy WebLinkAbout23833-z BUILDiHG PERMIT
(THIS PER~IT MUST BE KEPT ON THE PREMISES UNTIL FULL
CC~PLETION OF THE WORK AUTHORIZED)
N? 23833 z
Date ./.../.~,~
.... 7' ............................................. , ~9..~
coun,¥ Va,, Ma~ ~o. ,000 Sect,on ..... ~& ......... ~,o~ ........ ,~
..... Lot No .........................
/
pursuant to application doted ........ ././..~.../..~.... ............................... 10..?..~.., and approved by the
Building Inspector.
Rev, 6/30/80
FORH HO. I
TOWH OF SOUTIIOI,D
BUII.DIN(~ I)EPAR'I31EHT
TOWN IlM,L
gOUTIIOI,D, N.Y. 11911
TEl,: 765-1802
lerm~t~ ~ ..............
/
I) | aappvoved a/c ............................ i .....
BUAI(I) I)1, IIt'.fil,'l|l
/3 SETS OF PLANS ...............
/-mmv~,Y ........................
/c111;c~ .........................
SEPTIC FORH ...................
HAIl, TO: ....................
AI~PI,1CATION FOR IIUII,I)TNG PERH~T
INSTRUCTTONS
Date ................ , 19 ....
a. 'lld~ al~fllcatlcm ,~mt I~ c.o,qfietely Filled in by /y~.~iter or in bfl~ m~l md~itt~ ~o the l~Hhlln$~ hml~etor wit
3 ~ln of pinna, accurate plot pt~
b. Plot pton vl~i~ l~atJ~
c. 'Ibc ~rk c~ by, th,~. ailflicati~ p~.l~t 1~ cc~,~t~l t~[ore ism~e off ~Hlding Pe~it.
d. Ulxm a~aI o~ thiff al~licati~;' the"l~Hdin8 Ins~tor wltt:is~ ~ lk~ildihg Pemlt to the n~llcant. S.ch
lwrmlt ghnl [ I~ kept ~ tl~ ~.i~s ~ailobte [or ins~ckim Ol~t the x~rk.
e. ~ Ixdldbl; vJmll I~ ~q)J~l or
' (~lmr~:y shah have I~n 'grm~l I~ tl~ ~dldln~'h~s~tor.
APH.I(~'I'I{~ IS I~IU~I~ ~ to 0~ l~fihlb~g l~rt~nk [or the ismm~e of a l~dldlng l'e~t la~rmm, t to the
l~Hldlng 2x~e 0rdi~a~e o~ 0~ T~m o~ ~tl~ld, ~ff~olk ~ky, ~q York, at~ other aHfllcable ~s. 0nli~es or
l~fiati~m, for tim camtn~ti~ o~ hdldi~s, ~itlgms or a/terati~s, or D>r ~al or d~lltlon, as Iwrelo
<~scril~l. '11~ appllc~t ages
re.flat:hms, a,~] to a~it m~O~riz~l inn~tors ~ l~ises a~l in l~il.dln8 for ~cessa~ ins~ti~m.
(Slg, mture of appllca~, or ~, i[ a cori~t*tlcm)
...c~l~..~[ ~ .~J. M..~. ~ ..................
State wbetlter al~Pllcaat ia cx~r, lessee, ageot, arddtect, engineer, ge~ral c~tractor, etectrlcian, pl~t~r or ladhler.
.... O~.a~ ........................................................................................................... ~.
~ o~ ~ o~ p,-~,i~, ...Pet~.E..~..~0oCAt¢..O.,..~acbin .....................................................
(se m tl~ tax wll or latest d~l)
If al~)licnnt i~ a corl~ratJ~b ~ig~tu~ off ~hty mxtl~)ri~l oEficer.
title of corporate officer)
(check ~JHd~ a[4~li :ahla): bl~ Ikiihlin8 .......... .~klithln .......... AlieraLioa ..........
.
AM YO 4. PM
COMPLEqE FOR
CONSTrUCT;ON
RESPONSIBLE FOR
((~)lJLrncLor,~l~l'~ c;orl×)rare ofl:Jc4r, elc.)
/Z~M§LEt~
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