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Home My WebLink About25613-Z FOI~ NO. ! TOI, IN OF SOIFI'HOLD BUILDING DI~PAR'I'H~NT TOI~i SOUTHOLD, N.Y. I ! 97 I TEL: 765-1802 INSTRUCTIONS CI~CK ......................... SEPTIC FORH ................... NOTIFY: C~L . ..~19:. ~.~..~ ..... I~IL TO: .................... and title of co. orate officer) I. I~cati~ of 1~ on ~hich propoaed ~rk viii be do~ .... .......................................................... ............................................................................... ......................... Subdivisio~ ...................................... Filed lisp.No ................ Lo~ ............... 2. State ~stin~ use ~ a. ~st!~ ~ ~ ~ ......... ~~~ .................................................. Repair ....~. ...... ~,.~1 ............. r~,,>lition ............ Other I~ork ............................ 0)eacriptioo) ~. Estimted Cost ...~.. f.~..~..~.'..~ff. ......... fee .............................................. (to be paid on filing this ~lic~tioo) 5. If doelling, ~t~r of daelling mits ....... f.... Bonber of d~elling mits oo each floor ................ If garage, ~r of Cars ...................................... 6. If business, t ..... ,:rcial or mized occupancy, specify nature and extent of each type of use ...................... 7. Dimensions of existing structures, if any: Front ................ Rear ............... Depth ................. Beight ......................... l~=nher o[ Stories ...................... Dimensions o[ sam structure vith alterations or additions: F~,c~-,t ............... Rear ............... Depth .................... Height .................... Nomber o[ Stories ............... 8. Dimensions of entire nea conatruction: P,-c~,t ................ Rear ............... Depth .............. Beight ......................... l~mber of Stories ..................... 9. Size o[ lot: F~t .................... Rear .................... Depth .................... 10. [late of Pm-dross ..................... l/are of Former O~ner ........................................ I I. Zone or use district in ~hich premises are situated .............................................................. 12. Deee proposed construction violate any zoning l~a, ordin~ce or regulatien: . ../~..~...' ................ 13. ~/ill lot be regraded .~.?......,. ........ ~/ill e~ens fill be ,~. ~,~, o~ O~r o[ ~Z,s-..~.~.g.~r. ....... ~rese .~..~...~ng..~.~.~/.~.~ ..... ~ ~o.~?):~7..c.z.... ~ of ~tr~tor .~d.~..e~?:~. ................. ~arese ............................... ~ ~o ............... 15. Is this p,o~erty ~rithin 300 feet of a tidal ~etl~nd? * ~ .......... NO .......... · IF ~, PLOT DIAGP. AH Locate clearly ~d distinctly all buildings, daetber existing or proposed, and indicate all set-back dimensions p,'op~rD] lines, give street and block ~s~ber or description according to deed, and shoa street ms and indicate ~hether interior or come._r lot. ~FAIE OF fi'~/Y(~K, SS ~ ~ ...~'~~ ..... ..... 1~. ~ ............................... ~i~ ~ly ~m, ~s ~ ~* ~t ~ is O~ a~lim~t (~,~ of i~ivi~ si~i~ ~tr~t) De is ti. ...... ~! ................................................................................... (~tr~tor, ~nt, ~ate oilier, etc.) of ~d ~r ~ ~rs, ~ is ~ly ~ri~ to ~rfom or h~ ~rfo~ ~ ~id ~ ~ to ~ ~ tile this a~licatioo; ~t ~l star--ts ~tai~ in ~is ~llcati~ a~ t~ to ~ ~st of his ~1~ ~ ~liefl ~ tlmt ~ ~ viii ~ ~r~ in tim ~r ~t [~r~ ~ ~ ~li~ti~ fil~ ~.