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Home My WebLink About25701-Z FORM NO. I TOl~i OF SOUTHOLD BUILDING DBPART~BNT TOI~i HALL SOUTHOLD, N.Y. I 197 ! TEL: 765-1802 BOARD OF NBALTB ............... 3 SETS OF PLANS ......... ...... SURVEY ........................ CHECK ......................... SEPTIC FORM ................... NOTIFY: CALL .................. I~_AIL TO: .................... Di~.:~,~ed a/c .................................. ~ APPLICATION FOR BUILDINC PE~IT ~ ~t~ of pl~q, m~ plot pl~ b. ~lot pl~ ~ l~ti~ of lot ~ of ~ildi~ ~ w~..i~, mlati~ip to ~joini~ ~i~ or ~lic ~i~ ~li~ti~. e. ~ ~ildi~ ~1 ~ ~i~ m ~ in ~le ~ in ~ for ~ ~ ~at~r mtil a ~rtificate of ~ ~1 ~ ~ ~,~ ~ ~ ~ldi~ ~t~. ~~ IS ~ ~ ~ldi~ ~ ~i~ of ~ ~ of ~ld, ~ffolk ~, ~ Yo~, ~ o~r ~li~le ~, ~i~s or ~ati~, f~ ~ m~tim of ~ildi~, ~iti~ or alterati~, or for rm~ or ~,~,liti~, ~ ~min &~i~. ~ ~plivmt ~s to ~ati~, ~ m &it ~i~ i~tors m ~s ~ in ~ildi~ for ms~ in~ti~. .......................... ............ ff ....... (Siam of ~limt, or ~, if a ~rati~) (~ili~ ~ss of ~licmt) le~,~i~t, ~i~,' ~ral ~tmtor, el~tricim, plier or ~il& S~te ~r ~li~t is ~r, (as on the ~x roll or latest deed) If ~t¥1ieant is a corporation, signature of iffy ~,thorized officer. ............................... (Ii're and titlff'of corporate officer) fflectricJ~--~ Licelse lb ...................... !. h~cation of land on sahich proposed work will be do~e ............................................................. ~I~1 et [louse Number Street 2. State existing use and occupancy of pr~i~s...~,...~and intend~l use and occupanc7 of proposed ~tructio.: b. Intended use a~d cecupam7 ............................... C/' ........................................... 3. ~.~ture of ~ork (check ~hich applicable): l~ I~ilding .... .~.... ~iti~ .......... ~terati~ .......... ~ir ............ ~1 ............. ~liti~ ............ Oti~r ~ .................................. 4. Esti~t~ ~st ............ f~ .............................................. (to ~ ~id ~ fili~ this a~li~ti~) 5. If ~lli~, ~r of ~lli~ traits ....~ ...... ~r of ~11i~ ~ics ~ e~ fl~r ................ 6. If ~i~ss, ~ial or ~ ~, ~i~ m~e ~ ~tent of e~ ~ of ~ ...................... ~. Di~nsi~s of ~sti~ st~s, if ~: ~t ................ ~ ............... ~ptl~ ................. t~i~t ......................... ~r of Stories ...................... Di~i~ of ~ st~e ~th"alteraCi~ or ~iti~s: ~C ............... ~ar ............... ~Pth .................... ~i~C .................... ~r of Stories ............... 8. Di~i~ of entire ~ ~t~ti~: ~t .... ~L~ ....... ~ar .... ~(.~ ..... ~p~ ..... ~f/ ..... [~i~c .......... [.~ ........... ~r of Stories ..................... 9. Si~ o[ lot: ~t .................... ~ .................... ~pth .................... I0. ~te of ~d~ ..................... ~ of Four ~r ........................................ I I. ~ or ~ district in ~i~ p~i~s a~ s~t~ .............................................................. 12. ~s ~o~ ~t~ti~ vlolate ~ ~i~ 1~, o~i~ ~ ~lati~: ........................ 13. Will lot ~ ~ .................... Will ~ss fill ~ ~ ~ ~s: ~ ~ 14. ~s of ~r of ~s ........................... ~ress .............................. ~ ~ .............. ................................. ~se ........................... ~ ~ .............. ................................ · ~ ~ ~ ~-~ ~ ~ ~ ~Y ~z~F ~ ~~ ......... ~ ....... ~ ~ ............. I~. Is this p~ ~i~ ~ f~t of ~ till ~tl~ * ~ .......... ~ .......... PLOT DIAGRAH I~cate clearly and distinctly all buildings, ~hether existing or proposed, and indicate all set-back dimensions property lines. Give street and block ~her or description according to deed, and sho~ street ~-~_s and indicate ~hether interior or corner lot. bin YO[~, ........................................................ duly ~m, i~ivi~ si~ing c~Lr~t) (~t~tor, ~nt, m~rate officer, etc.) ~r or ~rs, ~ is ~ly ~t~ri~ to ~rfom or ~ ~rfo~ 8e aia ~ ~ to ~ ~ file this ~lication; ~at all stat~nts ~tai~ in ~is a~li~ti~ am t~ ~ ~ill ~ ~rfo~ in tl~ ~r ~t for~ ~ ~e a~liati~ filed ~. ,~rn to before me this / ........ .... dey ELIZABETH A STATHIS NOTARY PUBLIC. State of New York No, 01ST6008173 Suffolk _Cou_~ty Te~ E×oires J~ne 8, 20~ ',?~' SCDHS Ref.~ CIO Septic Sydern ~' I- 2500 Ed. Septic Tonk ~-I0 ~ ~ 9' Deep Le~chin~ ~0"~ ~bove Er. ~der ~'~ ~ A B ~~NTS NO TE* SUBSURFACE SEWAGE DISPOSAL SYSTEM DESIGN BY* JOSEPH FISCHETTI, P.E. HOBART ROAD SOUTHOLD~ N.Y. 11971 (63U 765 - E954 SE~ TIC DESIGN 4 UNITS A T 300 GPD e~ch MAP SHOWING · UNITS 49,50~51 & 52 A T GREENPORT TOWN OF SOUTHOLD LEACHING POOLS 4 x 300 GPD = 1200 GPD / I.~ ~ /~r- eoo sF SUFFOLK~.~OUNTY, N LEAC~NG AREA ~- ~.~ PROVUE 3 LP /0 foot ~ SC~: F' = 30' 9 ~oo~ ~ - e4~ ,~ ~y 8, 1999 /- ~/~*~"~ ~ ~.//r Dec. /4~ /999 (septic s~stem) DROSSECTION SEPTIC SYSTEM ~~ Y TO C~ Y .~ ~ ~, ~ ~ 'AL 7~ B~ 'F~ '~ S ~ '~ LIC. NO. 49618 765 - 1797 93 '- 300 (49,50,51, & 5Z MAP SHO WING UNITS 49,50,51 & 52 PHEASANT RUN £SrA TE~ A T GREENPORT TOWN OF SOUTHOLD $UFFOL~_~OUNTY, N. 1000 - 40.01 01- ~30,$I & Scale: 1" = 30' July 8, 1999 9.3" 300 (zt9~50~51~ & 5E