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Home My WebLink About17556-zFORM N0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No 217918 Date APRIL 3, 1989 THIS CERTIFIES that the building ONE FAMILY DWELLING Location of Property 33000 MAIN ROAD RT. 25 House No. Street County Tax Map No. 1000 Section 19 Block 01 Subdivision Filed Map No. conforms substantially to the Application £or Build filed in this office dated OCT. 17, 1988 ORIENT Hamlet Lot 14.005 Lot No. ing Permit heretofore _pursuant to which Building Permit No. 175562 dated OCT. Z5, 1988 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. (UNFINISHED SECOND FLOOR) The certificate is issued to CHARLES E. & LAURA H. BAKER (owner, ) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 88-50-126 FEB. 27, 1989 NO. N053889 MARCH 29 1989 PLUMBERS CERTIFICATION DATED KING PLUMBING &, HEATING INC 12/28/88 Building Rev. 1/81 Inspector .,,~ ~~, ~f~~. ~; soaas xo. s TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT CfHIS PERMIT MU5T BE KEPT ON THE PREMISES UNTIL FULL CAMPLETION OF THE WORK AUTHORIZED) N o Z Date ...~~.~ ................. Permission is ereb gran~te^d to: ,/~ ~~ 'f''.... ~. ~Q~i1d...'1....'...~ ................ y?~, .~.~s ................................................ .... ...~~:..~.~.-.......... ii ~.~,7 ............ ra ..~.~~`..~:.......... ~~........~ ........a~~~:...~....... . ........... . ~3ood ~ ~p ~'~ )1 at Premises located of ....~..~..:~.r~..~--, ~..'`.~.. /.L~. z~}a!....~~ ~.x~.,.~• .................... .L~~~~~ ... '... ~.......~ ................................ ................... y ' V qq .... Cvunty Tax Map No. 1000 Section ........ ~.l.......... Block ..........~........ Lot No..~. ~....1..,7.t.~ pursuant to applic6tion dated ..~~ Building Inspector, fee $....J~..~2..<~ G17556 r"r ............................... ~~ .~9~~and approvedGQ~V! i '~ r ~~ . ~~ ~uildm for Rev. 6/30/80 ,.. , TOWN OF SOUTHOLD BUILDING DEPART2fENT TOWN HALL SOUTHOLD, NEW YORK 11971 765 - 1802 ~ ash 3~ APPLICATION FOR CERTIFICATE OF OCCIIPANCY DATE....APRIL.1~.1989 NEW CONSTRUCTION .,~. OLD OR PRE-E%ISTING BUILDING......VACANT LAND........ 3300 ~ 1 -7 Location of Property.~.~..e ...............~.r~~~..,,......,,,,,,Q/4lCN(..,., HOUSE N/0'+. STREET HAMLET Owner or Owners of Property~~arfe~,~e,~ ,~~~~,,~-(r_.~~K~~.___.__ County Tax Map No. 1000 SecCion a.9.... Block .~....,. Lot 14.005,.. Subdivision ....................... Filed Map ..._....Lot.......... Permit No.017556Z__„Date of Permit l~~ZS~gg..ApplicantCHARLES E.+ LAURA N.BAKER 88 S O 12 6 ((~~,,qq,,~~ Health Dept. Approval ................ Underwriters Approval6.J.~.1589/89... Planning Board Approval ................ Request for Temporary Certificate ....... Final Certificate .,l\............ Fee Submitted: $.~ ~~.~..........., APPLICANT... ~~~~": ! `, 4,' , ~./, ; ! ~~~, _ , , _ _ r~17Ct2Le~ c` ~~2~ei ~~ ~ e ~ rev. 10/14/88 J • ~ TEL. 765-1802 x'05"" °"I ~pG TOWN OF SOUTHOLD Z y~'C OFFICE OF BUILDING INSPECTOR z P.O. BOX 728 s ye TOWN HALL "',O`0~ ~ ~~p`c 50UTHOLD, N.Y. 11911 C E R T I F I C A T T O N Date /~/~u~~~~ Building Permit No._Co/Z~S~ Z' Owner G~ ~ ~ ri/~'~G-.~- (please print) (/ Plumber ~'vc~ ~lti.~z,. 6r~~ d-lle~f~~ I n>c - (please prin ) I certify that the solder used in the water supply system contains less than 2/10 of 1~ lead. Sworn to beforrre~~ me this d ~ day of A/~- 19 ~'~ . (plumber's sig ature) Notary Public Notary Public, u ,i~ County NELEN K. OE YOE NOTARY YU01rC, State of New Yarn Na. 4707878, SuNolk Count Term Expires March 30,19 1~LD i::SPP~:iu:~ - ~~Ui,ir. - I %UaKMENT° ~, I F `~/~ m ~ H ,..3 FOUNDATION (1st) _ _ ., .__._ ~ ~~ c FOUNDATIO[ (2nd) - _ m~ 2. z 0 ROUGH FRAME & PLUMBING 3 '~ . a ' m m IIJSULATIOfI PER N. Y, ., y ' STATE ENERGY CODE m f ~ ~ _' ~ r "°i(i ~ FIidAL ~ i \ o ~ ADDITIOfIAL COMMENTS: _ m x :.~ `~ x ~v H a H H O 4 m p ' ~ t H (. x C • - p 1 m ~ y Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD October 17, ]988 State of N.Y. D.O.T. Veterans Memorial Hwy. Hauppauge, N.Y. 11788 Dear Mr. Kuzloski: In addition to any comments on the submitted application, could you please send us any standard forms or applications that would aid our Building Department in these matter. Thanks, Thomas J. Fisher Building Inspector oS~FF°`^.~ TC7WN ^F 50UTHOLD S ~~ ~, OFFICE ^F BLJiLDiNG INSPEGTpR °By~l*~~o~ TOWN CLERK'S OFFICE 5OIJTHCILD, N. Y. Date ......IO ~~ ~~~J ...................... ~~ ~~ Mr. , ~, 61~ ks ~Su~4ell~-Fennt7r ~~ °~~ ~ Dear Sir: ,Ll2u~'a~faG,y~:.ey~~ yy, In accordance with Section 239K of the 6enernl Municipal Law of the consolidated Laws of the State of New York, is_ u,Gic r s o ~r~~.E.~ ., /- - - _ ..~°.:.. ............. .... ..........that.......................... ~...... has applied .to the Town of Southold for o permit to construct a buildin c~1 // yyy~ ~ ~~ ~9 /000 _ 9/~ , Po../~ ... oaf ~~8g as shown on the attached plot plan, submitted in triplicate, doted ........ .........................................and titled ~.~!~....~~..G~'."""" yy....~2~7!.`.;~f:""~O We shall withhold further action on this applitotion fort/ten days or as otherwise provided in the aforementioned Section 234K. Very truly yours, <~~~~ Building Inspector Town of Southold, N. Y. fl~f 1.,q ia~~ October 1'~, 88 Southold Town Building Dept. Town Hall Main Road, Southold, NY. 11971 Ched Baker POB 350, Orient, NY. 11957 Dear Folks in the Building Dept, I am including this letter of intent with our permit application to clarify this construction. We own this 2 acre lot and my wife, myself, and two young children are living in the small cottage located on the northeast corner of the lot, noted on the survey. It is our intention to demolish the cottage as soon as the newly constructed modular home is in place. We intend to apply for the demolition permit in the near future, and have already acquired an estimate for the work. If you have any further questions concerning the permit, please give us a call at 323-2573. Thank you. Sincerely, C?ltady ~~~ FORM N0. 6 ~a~~a.,~axr-4r-fJ2~-~, '~. h ., ,.~ T041N OF SOUTHOLD BIIILDING DEPARTMENT , TOWN HALT. ~ ,r.,~sd ' <. .~ ~ 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY INSTRUCTIONS A. 'This application must be filed in typewriter OR ink and submitted to the Building Inspector 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 features_ 2. Final approval of Health Dept. of water supply and sewerage-disposal(S-4 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that solder used in system contains less than 2j10 of IZ lead. 5. Commercial buildings, industrial buildings, multiple residences and similar buildings and installations, a certificate of code compliance from the 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 pre-existing land uses: I. Accurate survey of property showing all property lines, streets, buildings and unusual natural or topographic features. 2. A properly completed application, a consent to inspect signed by the applicant and a certified abstract of title issued by a title company which shall show single and separate ownership of the entire lot prior to April 4, 1957. If a Certificate of Occupancy is denied, the Building Inspector shal_1 state the r^asons~therefor in writing to-fhe applicant, 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent information required to prepare a certificate. C. For Vacant Land Certificate of Occupancy: I. An application for vacant land Certificate of Occupancy shall be submitted, and a certified abstract of title issued by a title company showing single and separate ownership of the entire lot prior to April 9, 1957 shall also accompany the application. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. D. FEES: 1, CERTIFICATE OF OCCUPANCY - New Dwelling $25.00, Additions [o Dwelling $25.00, Alteration Co Dwelling $25.00, Swimming Pool, $25.00. Accessory building $10.00 Addition to Accessory buildings, $10.00. - Businesses $50.00. 2. Certificate of Occupancy on pre-existing dwelling - $100.00. 3. Copy of Certificate of Occupancy - $5.00 - over 5 years - $10.00 4. Vacant Land Certificate of Occupancy - $20.00 5. Updated Certificate of Occupancy - $50.00 6. Temporary Certificate of Occupancy - $15.00 rev. 10/14/$g • r ,_ ~~ ~~~`'~ 1~~~~ rss-xso2 BUILDING DEPT, f NSPE~TION [ ]FOUNDATION xST ( ] ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ FINAL REMARKS: ~`~° ~ - ' DATE INSPECTOR 17 ~{~ ass-iso2 BUILDING DEPT. INSPECTICaN ()FOUNDATION i5T ( ) ROUGH PLBG. [ J FOUNDATION 2ND [ ] IN .CATION FRAMING FINAL [] [ REMARKS: ~ i~ `~'- DATE l a ~ ~l ~ ~ ~/ ~ ~~ ___~. ~7sr~ rss-1saZ BUILDING DEPT. 1 NSPE~TION [ ] FOUNDATION i5T [ ] ROUGH PLBG. [ FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL,/ REMARKS: -~` ~" DATE ~~ V INSPECTO ` I ?ss~ 765-1802 BUILDING DEPT. INSPECTION [ FOUNDATION 1ST [ ] ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL 'z DATE /~ ~ ~~ INSPECTOR E ~~T~ REMARKS: ___~~~~"~ "" . ~o 4: ^. I~ ~ ~ ~ ~ - ,.. I ~~~ ~~~,~ . = .... _ . ~~ ;~ 1 m n (~ m a~ Ao t ~~ I z , c N IFm of A A ~ a z ~~ ~m v S fl '~ " iy "~ m u 2 r- p_ m m a }~, m N c ~~*J ~ ~1 ~ ~ I: z~1r -i ~ , {v~1 g ; , °~'~=~°= sg are :" ~~,~ Y~ a X - ~K"g G~g.~ ` re r p n Ca~n4>. Q.Bm; ; u~ nt ~ ~ R u~ `~'~ ao s` ~ !1 Z t' Q ~ ~® ~~, cee a=0r~mm Afll.y~ A ~ m m ~ < O m :'~ n x co Nc m y O t A m° ~ .D v 7 ,•~ 9 ~ ~ O O ,~ r m s Ori 'n x ~ r _~ l ~. ,' ~ ~ ~ ' .., V ~( Yg ~ r ~ ~-1 ~'1 . y r't"~ ~% Y ~ '~ ~ ~ m ~ r ~ O1oOmF x'~ ~' v' ~ ~ ; +^ + r ~ v;i y , ~ cT `C O -' m o~~Na y ~ a i oACm Orr? ~ x ~~ 1 ~ m=K~ .' T~ sm ~7T? Nr ~ ~ ~ x ^t i . p0 + T p - ~ _ p m m + O h m a a H F m ~ ~ o M '"nd N C O ^' p w ~~~ ~ m x r a ~ m r r 2 ~o ~~ N ! I o c "o ~~+'m -• L° sY o y m m w ~ Q °1' , n r.~ Cb d ~ ?C BOAKD OF HEALTH FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL fiOUTHOLD, N.Y. 11971 TEL.: 765.1802 Examined /~~~..U .~.., 19 ., . -'7 rr Approved ./ /~~~~(.., 19 ... Permit No. ~. /. J.~~. Disapproved a/c ..................................... 3 SETS OF PLA S .:..... SURVEY . ... CHECK • • ~~. SEPTIC FORM ,,,,,,,,,,,,,: NOTIFY ~~/r~~~~ CALL MAIL T0: .. / .......................................... o (B ldin pe tor) APPLICATION FOR BUILDING PERMIT Date ...Octobe;, ,1.$: , , „ 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 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 removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit c::thorized ir~pertors en nremises and in building for necessary inspec 'pns. ~ ~J ~~~• ..... l,Gt.,. ~... .. ......... (S~`g'na4ure of applicant, or name, if a corporation) POB 350, ORIENT, NY. 11957 .............................................. (Mailing address of applicant) State whether applicant is owner, lessee, agent, azchitect, engineer, general contractor, electrician, plumber or builder. ............................................................ ..........OWNER .................... Name of owner of premises CHARLES E :.BAKER. and .LAURA, H,., ,BAKER , , , , , , , , , , , , , , , , , , , , , , , , , , ............... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED ~ Builder's License No. ....13109~HI, . , , , , , , , , . . Plumber's License No. . , ,1059-P .............. 2334-E Electrician's License No . ...................... .~_3 O ~ ~ 13213H2 (EXCAVATOR) Other Trade's License No . ..................... ~ CJ _ 1. Location of land on which proposed work will be done. , , SOUTH SIDE OF RT 25 ORIENT , NY ........................................... ACROSS FROM THE OLD CHARLES ROSE AIRFIELD House Number Street Hamlet ,/ County Tax Map No. 1000 Section ...019 1 n,~~` ~" 1 /~ > ........... Block .................. Lot................... Subdivision ..................................... Filed Ntap No. .............. Lot .............. . (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy RESIDENCE , , , , , , , , , , , , , . .................. ......................... .... m »~ b. Intended use and occupancy RESIDENCE ................................................................ I ****PLEASS NOTE THA'N` THE EXISTING STRIICTURE (#7) TO BE DEMOLISHEb Nature of work (check which applicable): New Building ' ' ' ' Repair .............. Removal ~ ........... Demolition .Addition ::::: •Other Work ati (DescfipYi, $95,000 ~~ ................... Fee.................................on).. Estimated Cost .................. ~ (to be paid on filing this application) If dwelling, number of dwelling units . j S.T.14G~)•;...... Number of dwelling units on each floor ............... . If garage, number of cars ..........:.................................:............................ ~. If business, commercial or mixed occupancy, specify nature and extent of each type of use .................... . ', Dimensions 12 existing structures, if any: Front ...34 ~ • • • • • • • • • Rear .... 34.'• ...... Depth ... ~ $.~........ . <* Height ...... Number of Stories .. ONE ................................................. . Dimensions of same structure with alterations or additions: Front ................. Rear ................. . pepth ......................Height ......4.8 , ............ • Number4$f,Stories ..................... . i. Dimension~g2f,entire new construction: Front ............... Rear ............... Depth ...2:7..4...... Height ....... Number of Stories ....... ~.~ ........ . ........... P• • • • ' ' ' 375' ~ • ~ ~ ~ ~ • ....... ~. Size of lot: Front 150' , • , , , , , , . Rear ......`)?0,', , , , , .. , .... De th ............. . " " " " " " ' HOWARD HOEY ), Date of Purchase ... ~~6~87...... Name of Former Owner ............................ . ............. RESIDENTIAL i. Zone or use district in which premises''are situated ...................... • .. • . • NO • • ?. Does proposed constru tt11 v t1aatt ny law, ordinance or regulation : ................... ... . 3. Will lot be re raded ~U~~' .~IN~`•~' • ~~~~ • • • • • .Will excess fill be removed from premises: * * * No p ~ ~ ~ • ~ • ~L~... Addres~'OB• •350,, ORIENT, ,Phone No ............... . k. Name of Owner of remrses CHARLE~a 323-2573 Name of Architect BAKER , • , , , , ,Address Phone No. •BENNET`C ORI,bT^ISRI OB •~97~,~ C[1TCHOGII~lone No.4-~5~7 7• ~ • • • Name of Contractor .............:......... . .. AddressF................. ......... . 5. Is this property located within 300 feet of a tigdal wetland? ~<Yes ..... No ..... *If yes, Southold Town Trustees PermitPLO~ DIAGRAM ed. Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from roperty lines. Give street and block number or description according to deed, and show street names and indicate whether ~teriororcornerlot. ***NOTE ON', #13, EXCESS FILL WILL BE USED WITH DEMOLITION #7 SEE STJRVEY, STATE OF NEW YORK, S S COliNTY OF ................ . I ....................... g .................. (Name of individual sr nmg contract) above named. being duly sworn, deposes and says that Ite is the applicant ................................................................. He is the .................... • • • '', (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 s',et forth in the application filed therewith. Sworn to before me this ............1'.7.. ..~..~~..dayof.' ~.~............•,19~.~ Notary Public, ...~'."`~~. ~• ~~'•" •~~- • • • • • County J ~~~ HELEN K DE VOE ~..... .. ~~`:~.. .. ~.. ~ .....~...... ~.~•L/ . . NDTAFY PUDUC, Stale at New York (Signature of appiicA r`t) Term~E4iip~ieBslMirch 30 lountyp -- #,'..wy3y _ l . ~~ ~ y £ _ " ~1 ~ ~~~ ~ Y ~ ~ ~ ~ ~" "t _, _ _ ~ " ~ ~ "~ ,~ ~ l~ -~,a'"i'+-Y~ f'~ ' f ' .~ ~1" _ -e,~~k`~ ,.y ~b ~ , r ;~~ ~ ~~ ,~~ f ~i ~, ~ . S YS ; ~,4y~m ~ f J~~ , t g a ' ~ ~~ ~ vyh ~~~ ~ ~ M1b 2 3/1- Y '~ .. F~ # t ` " ~~; ~ t _ ~ x^"+34 » Y '~'~' k; ~ _ V'hV .. ~ ~ .. „r a ~ ,." ~ E __ f d x"M1 X13.. Y" ~f~ f ".~ /~ i r ;~" z- a ~~ ~, t ~m ,a ~1~ ~ S1~~.. ~ 3 ~ z - ~. `4. ~ ' ~ < ;., t h~~, ~ ~. .~..;ra fI }~ , ~ ~ ~~ 3 t ~~ ~ ~ ~ ~~ 4 .. ~ ~ _ ~ ~ -v ac ~. r ~_ €~ fA 3 ..y" ~ 1 ~ 4 '~ ~. /PTA\~ ~. ~" `Y 2"'F'~yti l.. ryl ~ pE d ~ (lm. (~~ iN' 1~i T~ <~~r~4~ ) «'Y+0. .y ~w~ ~ ~-v ' ~ F ~~Hf i " ~-a _® ~vnuF,v~ a(n]u,1 .~,~7I s C ~i v'~~~~~ ~~ ~ zo-+ ~ ~'~-~ -ice sue: ~` .. ~~~j'~uu ~~ o"o"~. o~Y,' ~ ~ ~ ~ "'~ "( ~ Q fA 1~f ~ rpi~ .(~~ ~. 3 m ~ c c ~ r ~} ~p yro y (/~ ~ ~ ~. ~ ° °,G `' a m ~_ ~ ¢ ° `" +, ~ ~ ~~ ", "0 w~r if ~ ~ ~ -i ~°-r~ m ~ d~j xo~+. a R < M f ~, ~sa~~ °r r yy~~ ~S M a ~ ~ m 0 ~ a a ~ ` ~ „ia r -! ~+ r _. m~~~ ~- --~~r3'7nq'rb N12r~Wa€vertRq M,qf r,~ \3+G ~~H~'~~ ~Q/1 -~~•=f ~~ t 0 ~^ L.. ~ r ;;. ~_ : ,~ :, t . +?; ~. ~.', ~! ,,r 6' \\ h ~~; p . ^~.\ m ,` , 1 ~~ . 1~ ,\ .a `,,. w~\ Gb /~ ~1AP C~F° P2C?P~~,T `r` ~urz~c~-~r~v Fo~z.-___-- ~. ~ LA~J~~~. SUFFOLK CO. HEALTH DEPT. APlRpVA H. S. NO. 8~" 50-t~ f tI /1- ~i { l ~ d.. \ _~ ~\ \~ ,N~L._ o`~ ~ .,~ ~t'f . ~~~ No. q ~. bL~ .. h' ~,~~ ~~ ~~~, / <~, sync svsrenl A"i° C3~ t E~tT ~ ~ ~ FEB ~^ "33 --- - - pE'T. QF .#, r ~ SE?tv~~F,S '~,, ~~: `~\ \`\ ~ . ~; ~~ ~~ \~ ~~~ ~4 ~~ 1T~•q .~~ _-- -- ~y~ "h .l ~-~ i ~ i~ <, ~} '. `'~ ~\ ~~, \ t }~~pp~y • C~'3a 1 ~ .. _F1~~.zal~~ SUFFOLK COUNTY DEPARTMEPJT OF HEALTH SERVICES SINGLE F,1MILy DWELLING ONLY oaTL~~~sgg~„ s f~Er tai. mac' e:1 c: Ttie S@W3 8 dl +' ~ location ',aye b . r ~~^ ly fa i;.5es ;~r this other €' ~ > '''~ ~ePartmantand/or ~$ ilci~ ~~u yy J' j~.ati y V+. ~y~E Ch,eflof Bureau o. Wastewate' Management PS.63e0?~3ci" W. f~?`.~ rA:ur,' OF HDEY lr'ACrtN?" .r _ _ . _.__. __.. L[CaDtIEO LAND StiRVEYARS GRE[NPORT NEW YORK STATEMENT fo?F INVENT THE WATER SUPPLY ANt~ SEWAtiE DISPOSAL SYSTEMS FOR THIS RfSipENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOI CO. D~)~OF HEALTH SERVICES. ISk~l6QQ_J~~"r,~ APPI ICANt SUFFOLK COUNTY DEPT. OF HEALTH SERVICES -FOR APPROVAL OF CONSTRUCTION ONLY DATE: H. S. REF. NO.: 8 8 " S O - 12 6 APPROVED: ___ SUFFOLK CO. TAX MAP DESIGNATION: DIST. SECT. BLOCK PCL. €OOG o€g i ~!o I:~, i t ~, ~:»c ~ :.3.25? 3 DEED: L. 6i5~ P.'74,$ t;:ct~F) . SILT`V r ~ 4S .. u y cnY ~ } ~~ -/) '. d O r NY Flu r . .. i ~ z io•nis r t,+~ V n~F f~Y etinn GCeJ h~ ebn ~`~ r v ~•nsae are not t anrbreb:u ~ 3:t6, fl1G'JiYI,aM (1f eu4eegUM1 u i6 ' ~ . . _ M:;e.~. lF{[OYNE qfi WI]P .. MIq~F,~ ~~Afi~~ ~~`' 2pgp '-; ~~ ro ~ mVEf ~'---_~..__ l ~ . -w _~ ~l~/ C= !~ ~~ `'~ .~. ~s~a ~~ ~ o ~ ~^ P'' e n, ` ~ , . t~ . '~. r" ~ y v wr l~ ~~~ ~ ' ~ ~~ / ( " ~5. V ,~ ~" o ~- ~~ ~~''. ~~ .. 1, ~ ~~ caa, , mt , , ~~AP ~~ PCZGP~~.7"1r' ' ~Uf~l~~-'~C? F4~Z A~~~ Q~~~~~ ~' J~1`~l Q~ ~JQ~tJTf-i . . ~~' ~ -.''~' ~}~_ ~.: WRLL ~~ ~h ~ ~, S ~~ r ~~~~ ~~~ ~~ r ~,~,I ~* ~o ~~,a~, ~ , .y %. b f% P~~' ;'~~ t~l s~~rlc sY~sreM SUFFOLK COUNTY DEPgRTMEPJT OF HEALiH S~R~lICFS SIhGI E Ft1h4iLY DtNELl.ItJG OhIY ~ ry r ~ar~~~ ~~5. ~Ei. i~Q. ~~. '~ l/ he sewage ~, . .~a,~ ~,f~:`;,- ~~~pty faci~iti~, tar th' 0Ceh01 aB~Q tr+-~,,;;~;;,~ ~ !S othe, ' `r'"° "Y 1:'~s DeP3rtmentard/or ' ~~ci~ ai.u fyy.~;i t~~~±ti~~;y. ;r~ ^rne ~J,6J°Q? ~,/~w L~ :~!v?i1~..;';,~~..~~lAl"i,~rti5 Cx.EFf~,~.`i~ M~g~A~y~l., ~.'~G` OF' HOEY . ~'vACr'~f J i~ ' ~p~~ 4~~.~ ~.._.~ FEfi ~" "~:~ L~il~~1LCS ,~~1J ,in: \,p~ {`ice. <% f [.. ,~ ,i ~~~ ~~~ S~AI.E ~Q=1p ~~ ,v~'~ MAf' AM~NR~U •~cT, 31~~q~e t ~._.... ~ -- -- - ,~, • i RCIDERlCK YAM TUYL,~:C'~' .r. _ 4~' ...~,. i ~~ LICENSED LAND SURVEYORS GREENPORT NEW YORK SUFFOLK CO. HEALTH DEPT. APPROVAL H. S. N0. ~ c:; .:.. ... STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE OISPOSAI SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK CO. D . OF HEALTH SERVICES. (s ~ k ~ APPLICANT SUFFOLK COUNTY DEPT. OF HEALTH SERVICES -FOR APPROVAL OF CONSTRUCTION ONLY DATE: H. S. REF. NO.: $ $ .. ~'~ - ~ ~:. ~' APPROVED: SUFFOLK CO. TAX MAP DESIGNATION: DIST. SECT. BLOCK PCL. ~J.,~. . 'y ~ ~. ~,i ~.~c. ~T~Irt~T, tv.Y. { i~r7 ^: } ~_~~ DEED: L. a~~~ P.`1~ `,.;; I:- i ,.;~ e~., a:~i...~ R:.'h4 •'.:.. ..; 31LTy ,::mow ,:: uon~ ,x~ ~ ~ ~-~~~., ! 5' , . ~w SILT ,r<~scn'or wh%;^.' "w : ',t'~ ~ SILTY ' ,.:,y. uu+,-nrnmcmr,l a.; ^r!.y ~,' . .. ~n:;iceticn I:e4tr1 h~xon ff:~~ SAND, c: ;too ~ac:,~?, aes .~ the la„c?n;; Ir,.,,~- ~1N~ •1p ~~~~ ~1/ j~5 Vrt.n -3~.,;~ y . ~f.i6c'&Ftt ll0i Si4n::'•IfI1M~Y M l g' r ~ _..; ~~ ,~I irf'uiuibm M ~uhldqu ~1 HE To ~~, :aa ~eGRAVE~. CDARSESIW 1Q'~~VFL w~Te~a i~- I I '; Id~o i1~thVE'L Rt[01'!rt 1011