HomeMy WebLinkAbout19764-z
y FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-20130 Date AUGUST 6, 1991
THIS CERTIFIES that the building NEW DWELLING
Location of Property 1325 WELLS ROAD LAUREL N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 126 Block 8 Lot 26
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated APRIL 3, 1991 pursuant to which
Building Permit No. 19764-Z dated APRIL 4 1991
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 ONE FAMILY DWELLING WITH ATTACHED GARAGE & OPEN PORCH
The certificate is issued to MOHRING ENTERPRISES INC.
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 90-SO-115 JULY 29 1991
UNDERWRITERS CERTIFICATE N0. N-196406 - JULY 22 1991
PLUMBERS CERTIFICATION DATED AUGUST 2 1991 - CHAS.SANDERS & SONS.
a
Bu' ding I Spector
Rev. 1/81
x. . ~
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TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWW HALL
SOUTHOLD, N. Y.
BUILbiNG PERMIT
(THIS PERMI~ MUST BE KEPT ON THE PREMISE5 UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
1 X764 ~7~
N 0 Z Date ...,:.r~.
`~T 19.(!
Permission Is hereby g nted to
...~!~o..~-~~-.~
..r..s1..~/...,. //~7~'
to ~ ~ ' ~
..............~.......e.....
of premises located at ......1.~..~....1.........~~~:~:6T,:.........~;:::.C
County Tax Map No. 1000 Seaton ~a 6....,..... Block Lot No.......
pursuant to opplicati~n dated . ~7 199., and approved by the
Building Inspector.
~ ~ sf
Fee 5..~`.,r.....:... ~,X
, , ~ wilding. for '
. , , ~
'
~ 1661 V Itll 11 ~ .
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Rev. bl30/80
Form No. 6
y TOWN l`: SOL'THOLD
BUILD'.: rrrARTM NT
: :TALL
'S5-182.
APPLICATION FOR CERTIFICATE OF OCCUPANCY
A. This application must be filled in by typewriter OR ink and submitted to the building
inspector with the following: for new building or new us.e:
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 17, lead,
5. Commercial building, industrial building, multiple residences and similar buildings
and installations, a certificate of Code Compliance from architect or engineer
responsible for the building.
6< submit Planui:,g Board Approval of completed site plan requirements.
B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and
'.'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 $25.00, Accessory building $25.00,
Additions to accessory building $25.00. Businesses $50.00.
2. Certificate of Occupancy on Pre-existing Building - $100.00
3. Copy of Certificate of Occupancy - $5.00 over 5 years -$10.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - ResidenCialpp$15.00,cC~ommercial $15.00
Date . 0..':.~:: 1 <
New Construction... Old Or /P/re-existing ,B(ylt~lding •
Location of Property.. ~ f !:.`Y' . . . < , ~e'~~.~Er~ h , . < _ _ , . .
House No.,(~ Street -~H^a~mlet
Onwer or Owners of Property...C.`Q:~:~.~~:v//h....~/VTE!~~/Pc~1r.Ejr.f~`7:~1.G
County Tax M//ap No 1000, Se/c ti/on....142:~?....Block......~........Lot....°.~.r~'
Subdivision C~.s..~,:..~77u~.i/!~f:..°.4:~1,~.~:....Fileppd Map~~.'~~~ON~~./Lotf~.......
Permit No..l~~.la~"f-..Date Of Permit...~.~./~..Applicant..C"1.a7.~+.~/~~:r!~...c~~~:.~~.VG•
Health Dept. Approval....l.:.°.'2~ ...........Underwriters Approval... /.':.a?sa'
Planning Board Approval
Request for: Temporary Certificate........... Final Certicate...........
Fee Submitted: $..°:~"r' ~
Qom.. y a.~s .
eo ~ aof3o APPLm~
~ ~t eo 7
THE NEW YORK BOARD OF SIRE UNDERWRITERS '
~ ; nCxL,,~ l
BUREAU qF ELECTRICITY
8S JOHN STREET, NEW YORK, NEW YORK 70038
Date of{.}l:Y r:~rt~~+' ~'if"ifs `7!!t:) T„ i~5f~~)l;}k:
AQplication No. on file.
a; tt i~l I i fCU. tlli,.1%
THIS CERTIFIES THAT
only the electrical equipment as deacrihed 6e/ow and introduced 6y the applicant Homed on the above application number in the premiaea of
P4uHft l.6C 'hlnpPM;kpF.IGF~.~, `ii SfU y2t~:i J'; 7t+). kt±~`ti„;;I% u~}Ida i~~ft,. ~:;=,~:kp;h, yV ,.Y.
in the following locat,~pt~ ~ BayGment LJ /et Fl. ? 2nd F'1. Section " Block~• Lot
H was exa.nened on andfound to be in contplianre uith the requirements q(thia Board.
FI%TURE FIXTURES RANGES COOKING DECKS .OVENS DISH WASHERS EXHAUST FANS
OUTLETS ECEPTACIES SWITCHES INCANDESCENT fIUORESCENT OTHER AMT K.W. AMi. K. W MIT. KW. AMT K.W AMT. H P.
I lJ,I~ f~!l
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S
DRYERS FURNACE MOTORS PUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS ~ UNIT HEATERS MUtil•OUTLET
z EEII DIMMERS J
_ AMi K. W. Oll H. P. GAS N. P. AMT NO A. W. G AMi. AMP AMT gMPS. TRANS. AMi H. P SYSTEMS AMi. WARS
NO.OF FEET
f ? iY 'e!'3 j
SERVICE DISCONNECT NO.OF S E R .V I C E
METER NO.OF OC COND. A W, G,
AMi. AMP. LYPE EOUIP. I ~ ]W 1 q 3W 1 B 3W 3,e' dW PER b' OF CC C ND. NO QF HIdEG OF~N ~ G NO Of NEUTRALS A. W. G.
lE0 OF NEVTRAI
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OTHER APPARATUS:
PQt}`i'1112'i''I.."i, ti.Y.
A" . ~ . i , ...i
I iiN; IU ri It};I, 'N;La;I"!~l{7.(.gil (`17:~i'P li z\ ;:~I %,jt'i i-i-~, ~ ~
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N; f: ({'P N(N;A III )b/; ~11W, ! 9 ci rTC{ ~ GENERAL MANAGER
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Per
This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials.
COPY FOR ~tUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MU5,7 NOT BE-A,4TERED tN ANY MANPiER.."
~h, ~ TEI}. 7G5~1802
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Coy,, ~ ~ fio~rr or sr~u~rana,~ ~
r x OL;'FICl; (7F BT3ILDING INSPECTOR ~
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~ . P.O. pQX 72$
eQt'+ '"rt arn~' ~ TQWN HAIL
'~O/y ~ '~•Q"c 3QUTHUID, N.Y. 11971
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;,~~BUiltlirlg Permit No.~..~ ~ .
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~ ~ : , P1ulrWar(;.~f~~~C y~.rIN~J~.I?_f a -~6/?J / ~~f.
(pleasE print) .
•
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f Y cortiEy that the solder used in the water supply sy stem
contains less than 2/10 of lb lead.
(pl bar's siynatuxo)
SUSAN EF. CONGERO
NiSTPAV PJBIAC, Stem of NewVNa
JWC1r2'S ..b ~f:;L()L'.: fl:l7 tl; 1.S No.9PJ618118 I
OuP18Yd h Neeuu CcuMy
cam~semn e~y'aa A+rO. ao, to 9~
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• 49 Nocary public
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IIJSULATIOAI PER N. Y.
STATE ENERGY .^-a+-wC~_ p
CODE
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ADDITIONAL COMMENTS:
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765-1802
BUILDING DEPT.
INSPECTION
[ )FOUNDATION iST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ]INS TION
[ ]FRAMING [ FINAL
REMARKS:
DATE INSPECTOR
19?l~ ~
T65-1802
BUILDING DEPT.
INSPECTIAN
[ ]FOUNDATION 1ST [ ] ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING lNAL
REMARKS: ~.C ~O~ ~ ~q ~~u~
a
' DATE ' INSPECTOR
` ~ ~
765-1802
BUILDING DEPT.
INSPECTION
[)FOUNDATION i5T [ ]ROUGH PLBG.
[ ]FOUNDATION 2ND [ NSULATION
[ ]FRAMING [ ] FINAL ~
REMARKS: ~,/l~ ~~!~e.e~
f - ~
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DATE ~ 1NSPECTO
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! ~ a
765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST [ ) ROUGH PLBG.
[ ]FOUNDATION 2ND [ INSULATION
[ ]FRAMING [ ]FINAL
REMARKS: ~
~
DATE Z' INSPECTOR
i _ , _
765-1802
BUILDING DEPT.
INSPECTION
[ )FOUNDATION 1ST OUCH PLBG.
[ ] FOUNDATION 2ND [ ]INSULATION
[~RAMING [ ]FINAL
REMARKS:
r
s
DATE ~ INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION i5T [ ] ROUGH PLBG.
( ) FOUND TION 2ND [ ]INSULATION
[ RAMING [ ]FINAL
R ARKS: ~CC'~S'f
DATE ~ INSPECTOR
I
1
765-1802
BUILDING DEPT.
INSRECTICJN
[ ]FOUNDATION i5T [ ] ROUGH PLBG.
] FO ATION 2ND [ ]INSULATION
[ FRAMING [ ]FINAL
REMARKS:
i
DATE INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
[ ] FO NDATION i5T ( J ROUGH PLBG.
[ FOUNDATION 2ND IN
[ ] SULATION
[ ]FRAMING [ ]FINAL
RE ARKS:
DATE L l INSPECTOR
T65-1802
BUILDING DEPT.
1 NSPECTION
[ ]FOUNDATION 1ST [ J ROUGH PLBG.
[FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [ ]FINAL
REMARKS:
DATE ~ Y ~ INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
[ FOUNDATION 1ST [ ] ROUGH PLBG.
J FOUNDATION 2ND [ ] fNSULATION
[ ]FRAMING [ ]FINAL
REMARKS:
ATE ~ ~ . INSPECTOR
D
' y BOARD OF HEALTH
ca ~a ~__~~~il;~ _ ' FORM NO. 1 3 SETS OF PL \:7S .
~ TOWN OF SOUTHOLD SURVEY
~m..a...- - - BUILDING DEPARTMENT CIIECF . .
p ~-3~ ~ a E!, TOWN HALL SEPTIC FORM
f~^
SOUTHOLD, N.Y. 11971
i TEL.: 765-1802 t:aTIFY ; Jl
FSl.L%~.~~c~t'. s CAL ~0~~. ~`~~L..
E nri Row .~~zt~s~~.x~a ,,.,.,`Y19~~.~ . .
Q / MAIL T0:
Approved 196./Permit No. ~~6. .
Disapproved a/c
" (Bu' ing In tor)
APPLICATION FOR BUILDING PERMIT
Date i:~ ~ `F 19 9
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 ~.nlai-
c ration.
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
sSiall 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
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 rem 1 or demolition, as herein described.
The applicant agrees to comply with all applicable laws, ordinances, building c e ou in o ,and egul ions, and to
admit authorized inspectors on premises and in building for necessary inspecti s
- - (Signature of applicant, r na e, if a corporation)
.fie-./~.5~:.G,~ I, .
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
p
Name of owner of premises ~ ~ . ~~,$'2S G
(as on the tax roll or latest deed)
If applicant is rp ra ' , s' ature of ly aut rized officer.
ame and title of orate ffic )
Builder's License No . .
> Plumber's License No. .......I~ZU. .
- Electrician's License No. .....-~~3-3
Other Trade's License No . .
1. Location of land on which proposed work will be done . .
..........................~1~~~:~~u~:l.~.~~.-~..~
House Number Street Hamlet
County Tax Map No. 1000 Section l2. Block Lot G........... .
Q
r~ s~ . ,~r.~.~~i~ C,~'G.E O1~ L~rS7
Subdivisio ~ e"1 Filed Map No.' Lot .
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ~GGGQ$ ~
~ ~ /.~-h2s'~~ ~/GL~e.~~12~
b. Intended use and occupancy .
~ i
3. net ur of work (check whine anpplicable): New Building , . , Addition Alteration .
p Koval Demolition ..............Other Work .
4. Estimated Cost ...(D. Fee ~ .
(to be paid on filing this application)
5. If dwellin number of dwellin ~i
g g g. g, units ~ Number of dwellin units on each floor . . . .
g
If era a number of cars , ~ ,
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use . . . . . . . . .
7. Dimensions of existing structures, if any: Front . ...Rear , , Depth .
Height Number of Stories .
Dimensions of same structure with alterations or additions: Front Rear , .
Depth
8. Dimensions of entire new const I Height Number of Stories .
juction: Front ....5~ , Rear ..dom.? De th .~S ~ .
P
Herght Number of Stories ~ ~ ~ ~ ~ ~ •
9. Size of ]ot: Front 50 ; , , , , Rear ..10.0' Depth ~~U:.40 ~ ~ • ~ ~ •
10. Date of Purchase 2 ~ ~ ' ' ' ' ' ' ' ' ' '
~e ~r1.~/.~............NameofFormerOwner
11. Zone or use district in whichpr~misesaresituated,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
12. Does proposed construction vio ate any zoning law, ordinance or regulation: .
13. Will lot be regraded , , , , , , , , , ,Brill excess fill be remov.@d from premises: Yes No
14. Name of Owner of pre ices 71!'F;hy~ac.l (Y~k~!%ti Address 323.~''{ek~'!~ ,phone No..~0.? ('by & ~
Name of Architect ,t~?'",~G~, w~~'.f~ti e~a-rQ . , , , ,Address ~~/!sod, c ~ui%/4 Phone No..~1G?F~'?a
Name of Contractor l!Qh!~t!~,( ~i,G~?`'.~-nG , , , , , , , ,Address ~Z3, eK Coup ~r G - rte/
11 ~ ...........Phone No...?~.... fI. .
15. Is this property withi 300 feet of a tidal wetland? eyes,;,,,,,, No.........
*If yes, Southold mown Trustees Permit may be required.
PLAT DIAGRAM
Locate clearly and distinctly all~l 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.
~I
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STATE OF NEW ~ORK~ S
COUNTY O A~ o ~
.
(Name ofi~~
d~dua/I.sligm. ~ ~ ' ' ' ' ' ~ • being duly sworn, deposes and says that he is the applicant
ng contract)
above named.
He is the ....C-~/~rYe'!L!-~1~ ~-a?~~~C . .
(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/
T ..day of ~u?~'~!y , 19 9/
Notary Public . ................~7~~,~-a;~~~Y, County
SUN/~N E.F. c;dMaE:rto'
No.3W818118
I~i?~a..Gwn~2-
Ekpbie 1 -
(Si ature of applicant)
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SURVEY FOR
MOHRING ENTERPRISES INC. Mar 9,1991
! JAN. 2,1991
~ NOV 19,1990
' OCT 29,1990
AT LAUREL DAiE' SEPT. 25, 1990
10WN OF SOUTHOLD SCALE I"=30'
SUFFOLK COUNTY, NEW YORK No 9o-oTOG
w VNLU rHW¢ED ur[RAnoN OR AOO1noH m Tx1s CERTI FLED TO'
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ADOR[u
~`L YOUNG a YOUNG R~IVOERNEADNNEW YORKE
NOTE • =MONUMENT O= STAKE .ALDEN W YOUNG, PROFESSIONAL ENGINEER
AND LAND SURVEYOR N YS ULENSE NO 12843
HOWARD W. YOUNG, LAND SURVEYOR
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SURVEY FOR
MOHRING ENTERPRISES, INC.
NOV 19',11990
OCT 29, 1990
AT LAUREL DATE. SEPT. 25, 1990
TOWN OF SOUTHOLD SCALE I so'
SUFFOLK COUNTY, NEW YORK No 90- o~os
K UIMUTM01112 ED ALT[RITION OR 4DDIilON ro THIS CERTIFIED TO'
svevfr Is a vla AnoN of SECTION 7209 OF THE VENTU ORP.
NEW YORK STATE EDUCATION LAw COMM A L MDR, TLE INSURANCE
MCOIIES OT TN13 3U11VEY NOT tEARWG TNf lANO
SURVEYOR'S IMKED SEAL OR ENt033 ED SEAL SNAIL
NOT tE CONSIDERED TO tE A VALIO TRUE COPY D q.R~ W, o~
KGU ARAN TEES INDIUTED HEREON SHALL RUN ONLY 70 ~ YO
THE PERSON FOR WHOM THE SURVET IS PREPARED o G
HEALTH DEPARTMENT-DATA FOR APPRO~A4L TO CONSTRUCT AND a Nls RENALF To THE 7171E CON PANY, DDVEAN- ~
N NCARtlT WAT[II \AIM.NI I MSOURCE Of WATER MIMTE .PUlLIC. MENTAL 10ENCY AND LEN DIMG INSiITV TION LISTED
N tl/f CO TA%NA? ptT 1000 S[C TION CLOCK ldT 3G.. HEIIE ON, AND TO THE ASSIGN E[S OF THE LE MOIN6 !e
MTNCR[ ARE 110 OW[L LIWt WITHIN 100 FE CT Of 7WS ?RO PCRTY INSTITU 710M OuARAN TCE3 ARE NOT TRAM SfERA CIE
OTN[R THAN THOSE 3NOWM NCREON TO ADOI TIONAL INSTITUTIONS OR SUt SEOUEN7
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YOUNG a YOUNG R'°ERNEADNNEWAYVOERKE
NOTE ~ ¦ =MONUMENT D= STAKE • ALDEN W YOUNG, PROFESSIONAL ENGINEER
ANO LAND SURVEYOR N Y.S LICENSE NO 12843
HOWARD W. YOUNG, LAND SURVEYOR
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• OCT . 29, 1990
AT LAUREL DATE: SEPT. 25, 1990
TOWN OF SOUTHOLD SCALE: I 30'
NO 90-0706
r SUFFOLK COUNTY, NEW YORK
x VlNUTN01112 C0 ALTCRA TI ON OR ADDITION ro TNIS CERTIFIED TO'
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nL YOUNG 8r YOUNG~RHEAONNEW YOR"KE
j NOTES • =MONUMENT D= STAKE •ALDEN WYOUNG, PROFESSIONAL ENGINEER
I AND LAND SURVEYOR N Y.S. LICENSE NO 12843
„ HOWARD W. YOUNG, LAND SURVEYOR
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SURVEY FOR
MOHRING ENTERPRISES, INC.
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
OCT . 29, 1990
A7 LAUREL DATE: SEPT. 25, 1990
FOR APPROVAL OF CONSTRUCTION ONIY TOWN OF SOUTHOLD scALE I 30~
NOV 151 /I,j SUFFOLK COUNTY, NEW YORK NO. 90- 0706
GATE R F. NO._ -
NUNAUTH01112C0 ALTCRATION OR A601TION ro THIS
SURV[r O A VIOL ATION OF S[CTION 7209 OF THE QqE Of N@~,
NEW YORK STATf COVCATION LAW
APPROVED Nco?IES OF TNro suRV[Y Nor fEARW6 TN[ lANO 4~' PLO W r `O,v~
SURVEYOR'S INKED SEAL OR ENfOSSED SEAL SHALL
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AMO d MIS fENAIF ro 7NE TIiIE CONPANY~ 60VERN- 0
N M[AR[fLWATQ ~AA1N ~.N1 • MfOVRCE Of WATER MIMTE _PINIL IC _ MENTAL AGENCY AND LENOIN6 INSTITUTION USTEO
N 111P/ CO. TAX MAP OffT 1000 fLt TION 128 N.OCR LOT 3,E_ HEREON, AND TO TN[ AESIONE[S OF THE LE NDINO
N TNERL ARE MO OW~LUMif WITHIN 100 FECT Of TWf MOP[RTY INSTITUTION 6UARANTCE3 ARE NOt tRANffERAfLE
OTN[R TNAM TNOff ;fNOWN N[REON ro A001 TIONAL INSTITUTIONS OR SUSSEOUENT
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NOTE ~ • =MONUMENT ~ = AKE . ALDEN W YOUNG, PROFESSIONAL ENGINEER
AND LAND SURVEYOR N Y.S. LICENSE NO 12845
HOWARD W YOUNG, lANO SURVEYOR
m NTI(LOGTRMOPWQWw1,SEPFICTAMN(fT1~C[ff?OOLS(MIINOMNNGEOM N.YS.LICENSE N0.45B93
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SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES MOH R I N G ENTERPRISES , I N C .
JAN 12'1991
JULsI~GLE ;~I}Y,DWELLING ONLY Nov. I s ; lseo
DATE y "'H.S. REF. N0. R'd So /IS' A7 LAUREL DATE: sEPr. 25,'isso
The sewage disposal and water supply facilities for this TOWN OF SOUTHOLD SCALE I so'
location have been msper.ted hythis Departmentand/or SUFFOLK COUNTY, NEW YORK ND Bo- oTOs
other ag~e,(p,q/~-le-s nd fou to s tisfa
.A la~2w- I~~ KUIMUTNORI2 CD ALTCRATIOM OR ADDITION ro THIS CERTIFIED T0~
~ sunvEY e A vIaAT1DM a S[CTIOM 1209 OF THE VENTURE ABSTRACT CORP.
Chief of Bureau of Wastewater Management . NEw YDRK ST.TE EDUCATION lAw COMMON 'C~"1~A TITLE INSURANCE
M COPIES Oi TNI! SURVEY NOT BEARW6 THE LAND
SVR VE YOR'S IMKEO SEAL OR EMBOSSED SEAL SHALL COM SnF.YE `~W `
_ MOT 8( CONSIOE RED TO !E A V4L1D TRUE COPY
THE P[RSONLfOR WNOMET E SURVEYpSLPREPARED 10 3AP~D W' } 01`
HEALTH DEPARTMENT-DATA FOR APPRDNAL TO CONSTRUCT p OG
AND ON NIS BEHALF TO THE TITLE COMPANY, GOVERN-
M MEM[ST wAT[R BIAIM NI 2 NSOURCE Of WATER MIw1TE ~PUKIC _ MENTAL AGENCY AND LENOIMB INSTITV 7I ON LASTED ~ ~j
R flRf CO. TAR MAP DMT?QQS! f[C TION 128 BLOCK LOT NEIIEOM, ANO TO THE ASSIGN ECS OF iNE LE NOINO Q1
MTM[R[ AIK MO OW[LLIMt WITHIN 100 FE[T Of THIS PRO?[RTY INSTItUTION OUARANTLLS ARE MOT TRANSFERABLE
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wILL CONfORN TO TML fTAMDARDS Of TML SUFfOIK COUNTY D[?ARTMCM7 N OI STAMCLS SNOwN NEREOM fROM PROPERTY LIMES
OP NtALTN fLMIC[f, TO ERISTINB fTRU[TURCS A1IL FOR AffLClflt tip ? ,
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PROPERTY LINES OR FOR THE ERECTION OP fEMCEb 'y.}f0 O~
GND SU[4~
ADDR[f8
"L YOUNG a YOUNG''°EE~~"~W Yo"~E
NOTE ¦ =MONUMENT STAKE •ALDEN W. YOUNG, PROFESSIONAL ENGINEER
4ND LAND SURVEYOR N.Y.S. LICENSE NO. 12843
a HOWARD W YOUNG, LAND SURVEYOR
m rTNLLOCAT1aawELLtwI,aLmcrANK13»A CLSarooLSta)fnwNNGLaN N.YS.UCENSE N0.45893
ARL nror nLLO oaERw~noEEf AND oR oAn oorAlNBO FROM orllue
BRAN018 4 SONS INC.