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Home My WebLink About18211-z ~ `~a FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20284 Date OCTOBER 16, 1991 THIS CERTIFIES that the building NEW DWELLING Location of Property 675 MULFORD COURT ORIENT N,Y. House No. Street Hamlet County Tax Map No. 1000 Section 14 Block 2 Lot 3.25 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 8, 1989 gursuant to which Building Permit No. 18211-Z dated JUNE 15 1989 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 AS APPLIED FOR. The certificate is issued to JOSEPH & EILEEN SANTORA (owners} of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 89-SO-44 - OCT. 10, 1991 UNDERWRITERS CERTIFICATE NO. N-198715 - AUGUST 2 1991 PLUMBERS CERTIFICATION DATED JUNE 4, 1991 - K&K PLUMBING & HEATING ..~/~'l/ Bui ding Inspector Rev. 1/81 roaxc xa s TowN oP 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) N _ Z Date .......~.~:!~?!-......~..~~i~ 19.~../ ° 1.$211 Permission is hereby granted to: a.~a.s.R::.~:....~~~~~.....c~... ~~-4Q1 .....................1............o of premises located at .....~~.rl.....~.r~-S~:~.........~. ..................r«::+Y.V'.................... County Tax Map No. 1000 Section ......c?.l.~........ Block ......Q.r~sr....... Lot No.....~.:~~~...... pursuant to application dotod ........~L..~~,....g 19.4..., and approved by the Building Inspector. I Fee $..~.~..~.:..~,.4.... . Building Inspector Rev. 6/30/80 Form No. 6 j~ r..~, , rµ.~ L~"r L~ ~ TOWN OF SOUTHOLD ~~A ~,7 ! I ; ~~~~t""~'~°"~`°-4 ~ BUILDING DEPARTMENT ~ i,r ii' QC~ ~ Q ~~9~ 765N1 02L ~ ~ Og9~ I ~ ~L.~:' r0"""^^'-~7~?"„~?~0~ 0 APP CATION P'OR CERTIFICATE OF OCCUPAN ?-aVl`(~! 0~ :~Os.J'i'hSOt,C1 ~N .~,~,~,..=,nm...w,.~Ar.~,,.y. 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 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 buildings 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 and r "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 b~lding.00, Additions to accessory building $25.00. Businesses $50.00. ,,_(X~~-11JJ 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 - Residential $15.00, Commercial $15.00 Date New Construction..... ( Old~jOr Pre-existing Building Location of Property..Y.~:S....f::~`.rU.e.®...`.':~.......Q~''.4:.;;(....../.~!`: .....~~.~a~.......... House No. aStreet ~ Hamlet Onwer or Owners of Property..~!`.~PN~..~...C(~-~~'''~.....nn. S~rvloif'~? . County Tax Map No 1000, Sec(((((//tion..'.I..........Block...... °~'........Lot..... ~ t ~S. Subdivisionr....~.1. ~lel}!:`~..U~.E'.'~.....~SiA•(fS ...Filed Map............Lot Permit No.J ~..°.:.~~.7'...Date Of Permit ................Applicant............................. Health Dept. Approval ..........................Underwriters Approval......................... Planning Board Approval Request for: Temporary Certificate........... Final Certicate.... Fee Submitted: $ /fit (~.P,C, yz$"0,1 . C a ~ r~~ ^~C~ APPLICANT . t77zn~s'~ TEL;,7G5-180? 5~~fatkc o OGy TOWN OF SOUTIIOLD , ~ OFFICE OF BU[LDING INSPECTOR ~ ~°S P.O. BOX 728 ~ TOtVN fIALL .a0~ SOUTIiOLp, N.Y. l 1971 of ~ ~ AIIGUST 7, 1991 "'m~„~~,"~ ~o~! AUG26199~ ~r~,,, V JOSEPH SANTORA t D/ 1895 SCHOOL STREET , ~4p~ EAST MEADOW, N.Y. 11554 "°'^~^~~~..t ~ R) „J To Whom This May Concern, We are unable to complete your Certificate o~L- Occupancy because of the following reasons. / nn application for Certificate of Occupancy _/i> not on file. (ENCLOSED) o [Jnderwriters Certificate on file. flee check is ( ,not on file.) $25.00 No Ilcalth Dept. l:pproval on file. No final inspection has been made. Please contact our office on this matter. Thank you for your cooperation. Bui]di.ng Permit Ik 1 8 2 1 1 Z Bui.ldi.ncl Dept. No Plumber ^ao].c1er Certificate on file. ( all permits involving plumbing being .issued after April 1,19B4 ) a.a.8 3.SW I..:ii.»+va e.~... C~UF~~(/I,C TEL. 7G5-1802 o/ N Old TOZVN OF SO~JTHOb.D ~ /•t:^ < OFFICE OF BUILDII~IG INSPECTOR ~ ~ c; o P.O. BOX 728 ~ r " u' ` u% ~ ~ ~ TOWN HALL %O! ~~0~ SOUTHULD, N.Y. 11971 C E R T I F I CAT I O N , Date Building Permit No. ~ ~ Owner -~f~r~C34~ ~~~*Ci~t'~. (please print) i` (please print) ~ I certify that the solder used in the water supply system contains less than 2/10 of l~ lead. _ ~-fJ`~ ~1~/~-C~G2-,~.lL/rte. ~ (plumber's signature) Swo to befor me this day of ~ ~ ~ j ~ 19~, l j~~ ~ Notary Public ~ tlotarp Public,L/W County i ERIC G. KOCH Notary Puplicc,, State of New York Na b2-2182100 T ~m E pil'ee January 31 1892 TEL; ,7G5-1802 S~~Fa~k~,~. ~O Op TORN OF SOUTIIOLD "a GtG,!~•: F. y~ OFFICE Or BUILDING INSPECTOR ~ ~{,'~41,''},r~_ ,T, P.O. BOX 728 . , TONN HALL ~ ~a~~ SOUTHOLp, N.Y. 11971 1 AIIGIISTp7, 1991 IS S 00 STREET, ~ ~2?~~" ST W, N.Y. 11554 ~h-- To Whom This May Concern, We are unable to complete your Certificate oL- Occupancy because of the following reasons. / An application for Certificate of Occupancy /is not on file. (ENCLOSED) / o tJndcrwritcrs Certificate on file. i'1ie check is ( ,not on file.) $25.00 /i,~l No Ilcalth Dcpt. Papproval on file. No Final i.nspc;ction has been made. Pleaae contact our office on this matter. Thank you for your cooperation. Build3.ng Permit I( 1 8 2 1 1 Z Buildi.nq rcpt. No Plumber 5~].cler Certificate on file. , ( all permits involving plumbing being .i;sucd after 11pri1 1,19B4 ) :'iELD I;:SP~;,:~Uii IIUAin ~ i;UPiMLNT~ .,r, ~ . - m on / ~ ~ ~I / _ i - _ _ _ H r'OUtJDATfON (1st) C T - . l.. rOUNDATI0IJ (2nd) _ _ m z. 9 ~ 4 ~ Z ° ~ ROUGH FRAME & * "I"^~ H N' /O ~ PLUMBIN9~/~ ~ v ~ Z ~7C'b ~ / y 3. y m I1ISULATIOPI PER N. Y. ~ • 'j STATE ENERGY oZ CODE _ 4. ~ ` dtil Q.GGri FZ;JAL r ADDITIOPIAL COMMENTS: ~ x~ . T' i ~ x ro • ~y H 9 ' H O wQ } ..(7 r i x o o ~ ~ I A m ~ ~ b~ ~ ~ ~ ~ ( ~ E e° ~ ~ ~ ~ z ~ A wn N• " (VV 9 Y. M mm N u Nu N i 6~ ~ M N EN 3 w A O 'A ~j O O y ~ N w < < _ Ip8 ~OODtiPN [ A~ N P O ~ ~ l ~i p r L/ y O y (h N i b~0 u~gr0 ~ O3 O O 1 wO < ~ ~ r.= ~ C ~ i 0.~66b E i ~ <Y A' y ~ ZQ 1{ 9 N N N~ M G N N N N ~ r V N OO1 p ~ O ' K ~ y i iN C Y ~ O ~ 1-1 Q C ; ~ ~ 'O ~Z ~ °m (~S H z .7~''~a~ ~ q~ STS y 2 m H N iD ~~c fi,. ~^~k~ `J ~ O pN a tP a•~,s ~ ~ z ''F N ~Y n ~ 2F y~ c p< M u ~ m ~ ~ ~ ~ m R ~ ~ ~ o N: n$w 3a ~ m ~ ,33 O ~ b T T C dz ~ mz S > S'w i ~ S 'n 9 e C 1~ < 4 ~ . m N < O .'v ~ < m 9 "3aN 3 ~I~ Dz'_i ~ z~ m mpg > n $2 > Ax m O ~ ; O ~ ~ ~ 4 G1 Oy N ~ ~ 3S<3 i y ~ ~ 1~ ~ 3d b ~p 3~' a 8~~' ~ ~ m° a SUMMARY OF TOTAL THERMAL RATING If the Total Thermal Rating is zero (0) or greater, the proposed design for the building envelope complies with the Energy Code. THERMAL TABLE AREA U-VALUE RATING USED A. ROOF/CEILING ~ll~25~ ~ 32 B. NET WALLS 3b~~ ° C)~5 ~ C. GLAZING Window ~ I y`fi" _ Window~1 ~3F 3 't Skylights 23 ~ .~.~3 01. FLOORS l__,_~5~ `L~ D2. BASEMENT/CELLAR WALLS ° Wall Perimeter `~35 Feet Exposure Above Grade feet Wall U-Value .C~9 Oepth of Wall U-Value ~ ~ _ Below Grade ~8_ Inches D3. SLAB INSULATION Slab Perimeter feet Insulation R-Value E. INFILTRATION CONTROL Conditioned Floor Area $q, Ft. f. SOUTH FACING GLAZING ~ South Glass/Total Glass Percent G1. Area/Gross Wall Area Percent Conditioned Floor Area Sq. Ft. TOTAL THERMAL RATING + 2-® ~.~{ED AR~H~~ TOWN'OF AEMPSTEAD BUILDING DEPT. ENERGY AT TRUCTION CODE FORM ONE. @~ P ~2 ~ ff `r tt ~ 2 2 ~("4.., ~ -~~1 a~~'~ ~'o. 792 Ty~~THE Si P~~ ~ SD-~9 AODIi. ~/3 ~ e rss-iso2 BUILDING DEPT. INSPECT`ON [)FOUNDATION 1ST [ ROUGH PLBG. [ FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL ~ REMARKS; ~ O'er- _ DATE INSPECTOR ~L'/i Tss-~so2 BUI4DING DEPT. INSPECTION [ ]FOUNDATION iST ( ~ !ROUGH P4BG. (]FOUNDATION 2ND [ INSULATION [ ]FRAMING [ ]FINAL REMARKS: ~ c~-- .~,.~-_s4Lz~ DATE ~ INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST ( ] ROUGH PLBG. [)FOUNDATION 2ND [)INSULATION [ FRAMING ( )FINAL REMARKS::~~~z ~G~ _ l.D~ D7? _s~`~ G~~e~ ~~lt~~ ~ ~ ? Gam`?~ t DATE ~ INSPECTO ~~L'~ T65-1802 BUILDfNG DEPT. INSPECTION [ ]FOUNDATION i5T ( ] ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL REMARKS: ~ gild DATE INSPECTOfR ~ BUILDING DEPT. l ° INSPECTION [ ]FOUNDATION 1ST ( ] 1ROUGH PLBG. [FOUNDATION 2ND (]INSULATION [ ] FRAMIN~i [ ]FINAL REMARKS: ~,I~.-~~ ~ ~ DATE l(~ INSPECTOR 765-1802 BUILDING DEPT. INSPECTIaN [ FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL REMARKS: /%r d~ 7d -z. _ U 1Ol DATE ~ INSPECTOR - r ( `li~~ _ G2~ C%zGGIG~~i 765-1802 BUILDING DEPT. I NSPECTit)N [ ]FOUNDATION 1ST ROUGH PLBG. [ ]FOUNDATION 2ND [)INSULATION [ ]FRAMING [~NAL _fR~EMARKS: ~~rti~ .ate-.~~-/~,I ~ opt ~~'~lcd~ ~L ~ ~ ~~~G~~ ~ DATE lP j 9~INSPECT'GR'/~ r ~P~r. ~ga>'~_ s THE NEW YORK BOARD OF FIRE UNDERWRITERS ,r'rit,"`~ ' I'99Ql,f>0 ~EIUREAU"O~ ECEC7RI61TY 85 JOHN STREET, NEW YORK;'NEW YORK 10038 ~ ~ ' 'Date Allf {iii:Y 02 r:I947 APPIeebtion No. on file H"~~ki,3 k?~4(8'~. iV 3937;f THIS CERTIFIES THAT only the electrical equipment as deaerihed below and introduced 6y the applicant named on the dhove app/icotion numher in the premises of g;ANT'C1ftLS; 6'1 r> t~.[A.,b'tll2f7 t:'fi. ; <)t<i.iSt~T, LY.. N, rr~~ C+Altf%"I"t`iC1f9b'l t, li~ t :i?ri in thefollowinq lncationg, 8 e ent L"J !st Fl. [_J 2nd FT. SeMion Bloek Lot ~7rr„ r 2~ I. 9" was examined on ~ and found to 6e in conLp/iance with the ret(uiremen[.c q(this Bonrd. iIXTURE FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAU5T FANS. OUTLETS ECEPTACIE$ SWITCHES INCANDESCENT FLUORESCENT OTHER AMT. K.W. PMT. K.W AMi N.W~ Ami K.W. AMT. H P. t57 3S Q3 ~.!'1 s. 'I,~ 1~ 9'sF~ t t~~ i, DRYERS FURNACE MOTORS PUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BEII UNIT HEATERS MULTI.OUTLET DIMMERS AMT. K, W ~ Oll M. P. GA$ H P AMT. NO. A W G AMT. AMP .AMi AMPS. TRANS. pMi H` p SYSTEMS AMi WAIIS ~~nn ~ NO.OF FEET SERVICE DISCONNECT NO.OF S E R V I C E AMT. AMP. TYPE METER I ]W L a 3W ] 9 3W R,e' 4W NO OF CC COND A. W G NO. OF HI-LEG A W NO. OF NEUTRALS ~ A W G. EQUIP. PER % OF CG COND OF HI-LEG OF NEUTRAL J j~i) 1,: fS ~ ~ .r f .r ~ OTHER APPARATUS: ~ tRCjTOft5:2,--1 'N,.1~<,6-T fl, p. ~ I ~ ?'f['F; FILklC'i,'it+t;' T,d~"s~K., t~{(. i~Cii,}~'~;-~J'P~q II F:LLM07t7; Js;LnCF t;. NOkTt('PC1R'f'; h'!; 11.71.fi. - GENERAL MANAGlR Per f~~ - f ~ 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 BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT,~E,ALTERED IN ANY'MANNER 7~+N.y. g. is ,r~\~~°/,/~~g~ BOARD OF HEALTH . K- D ~ . ~ 3 SETS OF PLA S ; FORM NO. t SURVEY . ~81~~ TOWN OF SOUTHOLD CHECK . . BUILDING DEPARTMENT SEPTIC FORM .t~!~:........... TOWN HALL BLUG.I)t"PT.~ °OUTHOLD, N.Y. 11971 NOTIFY TOWtd OF SOUTHOLD v TEL.: 765-1802 CALL 79~~'~~~ ~ Examined . ~ ~ 1989. . MAIL T0: Approved 1989. Permit No..I. $ a.U q,~e~ Disapproved a/c ~ p ~ (Building Inspector} ~ APPLICATION FOR BUILDING PERMIT Date ..-.jU1J(v 151 ti 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 Iespectb'r~wi11`issued'a I3YUi18ing Permit•to the app'licaitt.- Suc$ permit shall 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 Occupaalcy 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 Constructipn of buildings, additions or alterations, or for,.re val ®r demol-fi n, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building o " e; lioti'siny e, and regulations, and to admit author}zed inspectors on p~ emises and in buildingfor necessai;y insp~ctio , , ."'(Sig' f ,e;pi applican ,.or name, if a corporanon) • - _ ~ (Mailing address of applicant) Ii>~ • h:'" ~ State whether applicant is owner, 1'essee; agent, architect,. eftgineer, general' contractor, electrician, plumber or builder. c~L-IN1=~ v - , Name of owner of premises A1~lTDP-..A . (as dIi the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. n . . (Name and"title of corporate officer) . ' f k • + Builder's License No. ~.P~. P~.~, r.`.~ ;'I-~ ~ ; `j ' Plumber's License No. ~`f°?~. P ~a'":~...!-- ' Electrician's License No. . 7. ~ 9~..... - - /~.,t-~.D . yy"'~."~•, Other Trade's License No . . 1. Location of land on which proposed work will be done. - L;>r7.5......... M U'Z:~'otz. ~ Co u Yz r C`:~?I Et`E t HouseNumbcr Street, Hamlet ,c~, 1 County Tax htap No. 1000 Section .......'`.l BI''ock 2.......... Lot ...~..°.2~....... . Subdivision ~.~~G.~~.°.1DVtEW.~ST7ZT~~..FiledMapNo. ,~I,®~,~j,......Lot....4~......... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy • , b. Intended use and occupancy ~~s~ , , , Slr~l'.,:,~N 1,1~'`` ~'L1-, ,y, ~ygo,~.., I, ~i ( ~ ~ . • Addition , 3. Napure of work check wh R~ applicable):'New Bdildin Demolition • Alteration Re air , . cmoval , . ' Ot er-~V~rle•.;.Yhq.. i. (Description) 4. Estimated Cost I~..l. ~ ? Fee " . ' ' ..i . ~ (to be paid on filing this application) 5. If dtvelling, number oC dwell~ng units , , , , , , , , , ; , Nt tuber of If garage, number of cars . • . , . C,+q~,,, , , , , , • . • • 1 ~'""`lltng units on each floor . , , , , , , , , , • 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use , . , ; t . . . . . . . 7. Dimensions of existlns struct'ures, if an • Pront , ,',<<:: ' Height Rear Deptti . . •••••....,,,,1~}umberofSt 'cs. Dimensions of same structure with alteratio or additions: Front Rear . • • • Depth...., ~ .Height. .Number of Stories. 8. Dimensions of entire new construction: Front , , ~7„ S, , Rear . , ~j.~•,~.~, . , , , , ,Depth • ~ • ~ • • `Height ..~~,5 , , , , , umber of stories , 2,, . ~ " " " " " 9. Side of lot: Front . •t• .;.,.t.. . • I~• ~~~Pil,~• Rear . ..~.CJ~¢ r~~t Depth fvI 5.• Q. . ,q, 10. Date of Purchase , , , • , • ~7 ' ' ' ' ' ' ' ' i • • • • • ~ • • Name of Former Owner -N:Ar~,a!~ , vG: , . 1 1. Zone'or use district in which premises are situated , t~. , , . , I, T~ , , , , 12. Dots proposed construction Jidlate any zoning law, ordinance or regulation: ~ • • • ~ ` ' 13. Will lot be regraded Y~'~'~'... ~ r ' ~ ~ • • • • • • • Nill excess fill be removed from re 1 Yes Ivlc P p . 14. ' Name of Architect es ~ ~ rJf~l~~Address a~~~'~,'`'Z'~, ,~r lt~~ 5i (p' cone ' ~ >°`~rf~0.~ ..........Address' ?;~7.-~UDITH~i ~~ib' ne No~./~v . ~:f~ ame of Contractor , ,Address , ~ Phone No. . y I~.Is Y is ro ert loin Tru P P y Bated with in~00 feet of a ti fl wetland? *YES....NO.y.. ' *If es Southold To~ ~stees Permit may be re uired. PLOT DIAGRAM , Locate cleazly and distinctly ~ll buildings, whether existin or g ~p>oposed, and, indicate all set-back dimensions from property lines Give street and blogk number or description accgrd'i~ig to deed, and show street names and indicate whether interior e~lot._„„ ~ ° D~°'~• ( •IQ . i ~ , ~D~' I~ c-~- ZI 85 ~ ~ao.o : ~y ~ I ~ ~ ~i.._., ~Y I, ~ N I ~raQ. ~ 53 . a v V~Cal~Li" `s ~ I 57. c ~ O II O `T~I~i' 1 Wo ~o.no 75 o SEG 11{ III ~ , 25 35 2.t~, ~ c STATE OF NE1V YORK ~ ~ c ~ COUNTY OF . IS.S • ~ ~ • • • ~ ~~p ~ • ' •SL~NnITE~IGpe• • • • • • • • • • • being duly sworn, deposes an says that he is the applicant (Name of individual sip ~ng contract) above named. He is the ~ , (Contractor, agent,~corporatc officer, etc.) • ~ • • ~ ~ ~ ' ' of said ovine or owners, and is duly authorized to pe~rfcyrm or have performed the said w rk and to make and Gle this aPplicaton; at all statements conta+ned in this application are true to the best of his know edge and belief; and that the work tvill be performed in the manner~sct forth in the application filed thcrcwit,h.. Sworn to before me this ~ ` ' .........~~Q.N~~...day oC I~.,jU~~,~........ \ . .,,19 Notary Public, . , l 4.(~/ ../Y County laEEN S. SANTO A ~ . lpTAlY PUYIt, SI.1. el' Iww Yak No. 90•.01601¢ GIIITIY 10111~PI,K OY 1 • • • • • • , • • • • • • • (Signature of applicant) ~I ' ~ Y - - ~ 5 i j"~{~"j{ r ~ c ' . .~~~~e „ r 2aa aCx Vw» .emu ~ 'fie (nj 2~r S1F ,a ma a ~.r £'d ~ ~ +j m o t4 ~ r N ~ Al 4f1 ' ~S 1 ~ t " P ~ s u m r ~ .,J~, ~~o vYt! ~ 111 ~ ~ . F: ~ W.. ~ c~ ~ ~3 y Ltf111 V fl ~ d ^L W~' _ ~ ~ ~a.: M f Q ~ t c r ~ ~ 4~~ ~ ~ ~ ~~iit . ~i Y r ` r _ ~ ~ ~ . v~~ f l 1 t / wad ~ 1 r~.I 1 4, [ 1 - ~ ~ ~ ~ r r~ ~^^+a4~h ~ ~ ~ ~ ~ ~ ~ ~ r ~ , ~ - - - ~ --~r . ; - .1 ~ 3 ~ r ~Ie ~ ~ r: {.z.,'; ~F~' h. F tit ~ ~ l i Q tj~ _ ~ s}:~x~ r ~ + t~~ . ~yygg~~~~ ~ o a ~ ~ ~ ~ _ ~ ~ ~ ~t ,,r Y ~ K ~ - ~ ~ 1: , ~ ~ ~ ~ ~ ~ ~ ~ ~w~:~~ a ~ " o. ~ ~ ~ ~ ~ ~ ~ ~ ~ 1, U~ m W f v a ` ~ ~ n a ~ _ ~ ~ ~ 1 CV ,~l w' f ~ r ~ ~ a ~ . '"t~'b " , ~ tl ° ~ ~ 'S~fy p 4 F ~~f' • ~ ~ ~ " _ _ ~ ~ ~ _i ~ ~ ..w..r M-..... ~ x ~ i ~ ~ ~ ~_r ~ ~ ~ ~ , ~ ~ ~ ~ t ~ __._.~.r~_._.,.__~_____~ . ,.._."._.__.__t I a ~ ~ ~ ~ 1- ~ ~ ~ f `~o~~.~ . ~ ~ ~ ~ ~q ~ ~ ~ ~ 4 ~ ~ ~ ~ ~ ~ a SUFfOIK CUt1At1Y U~PARiMENT NEAlTti SERVICES ~ .".J~: ~ , . SINGLE pAMiCY ~IElti 9 50 ~ ~ ~ ~ of ~~"~t DR ,~.H.S. REF. 'Ch~ wa~d+~s~wal aad water su piY 4acitities for`tdis lacaban have Veen raspectecl 6y this pgpartmeMt~ad/C1 ! - , ies an tou~ 1 fat 9ur~au M Wastewater Management'' ~ e, U ~A~.-~'~~ E W b,P1 Y~ 52i°i4'4o°E gw.l21 I~' m LOj' 21 ~ N o o ~ ~ ~ ~ ( z,, b ~ o I ?6.7 1 ° N 1 ~ Q o ~ 'Se ss.,o - 2o7a~eyuu _ m _ _ 53 bWE~. H - 190 A ?s.o o 5,,o O V,~.c,D.1.17 IN a~s.° ° tJ7 /i.o~ 3 a l71 ~ uo fl {1y\\\ ~ b O J O N \ D O / 3s2.o5 / 'V,~~O --Y-- y ~ rS ~a 2I° 141 ~o°1J lo°j.52 ? o M ~LFO~r~ CovK'.T ~ I = _ / 2~EµED ARC/yT JN AgRO Fir vaG~ 1.17 ~ P 2 * 1~~r ~ pL07 pLAi.l `FP~~rynF THE StA EOf A~3 ' hCALE I°=50 ~~V1"" / SCnLE ARF'ROV EU BY DRgWN BY OFTE' REV15EO ~I OflAW ING NUMBER 13%L IPIx1F00N N01000N LLEPx~PINin