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Home My WebLink About52139-Z ofS ,� TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, NY BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit#: 52139 Date: 07/31/2025 Permission is hereby granted to: Nathan Brzozowski 265 Union Ave Belleville, NJ 07109 To: Demolish existing foundation and construct a new single-family dwelling with a breezeway, attached garage,outdoor shower and HVAC system as applied for per Trustees, DEC, and SCHD approvals. Premises Located at: 34460 Route 25, Cutchogue, NY 11935 SCTM# 97.-2-9.1 Pursuant to application dated 05/22/2025 and approved by the Building Inspector. To expire on 07/31/2027. Contractors: Required Inspections: Fees: Single Family Dwelling-NEW $3,780.00 CO Single Family Dwelling-New $100.00 Total $3,880.00 Building Inspector TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone (631) 765-1802 Fax(631) Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only PERMIT NO. Building Inspector: MAY 5 Applications and forms must be filled out in their entirety. Incomplete applications will not be accepted. Where the Applicant is not the owner,an Owner's Authorization form(Page 2)shall be completed. Date: OWNER(S)OF PROPERTY: L Name:Nathan Brzozowski =CTM 1000-097.00-02.00-009.001 Project Address:34460 Main Road, Cutchogue NY 11935 Phone#:631.381.5613 Email:nbrzozowski@gmail.com Mailing Address:265 Union Ave, Belleville NJ 07109 CONTACT PERSON: Name: Nathan Brzozowski Mailing Address:265 Union Ave, Belleville NJ 07109 Phone#:631.381.5613 Email:nbrzozowski@gmail.com DESIGN PROFESSIONAL INFORMATION: Name:Mark K Schwartz Mailing Address:PO Box 933, Cutchogue NY 11935 Phone#:631.734.4185 Email:mksarchitect@optonline.net CONTRACTOR INFORMATION: Name: Carl Schmoger, dba Cobra Home Improvements Corp, LIC# 20527-H Mailing Address:16 Tex Court, Islip NY 11751 Phone#:516.780.1806 1Email:carlcobraconstruction@yahoo.com DESCRIPTION OF PROPOSED CONSTRUCTION WNew Structure []Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: []Other 2,000,000 Will the lot be re-graded? ❑Yes R No Will excess fill be removed from premises? ®Yes ❑No 1 PROPERTY INFORMATION Existing use of property:Vacant Land Intended use of property:Single Family Home Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to R_80 this property? ❑Yes BNo IF YES, PROVIDE A COPY. Check Box After Reading: The owner/contractor/design professional is responsible for all drainage and storm water issues as provided by Chapter 236 of the Town Code. 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,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 authorized inspectors on premises and in building(s)for necessary inspections.False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the New York State Penal Law. Application Submitted By(print na e :M rk K. Schwartz ®Authorized Agent []Owner Signature of Applicant: Date: 057/1 Z,� Z OONlStateB NCI STATE OF NEW YORKe ) Notary Public, of New`/ur SS: Nct.()1BU6166056 COUNTY OF �U 01 Qualified in Suffolk County C mr ission Expires April 14,2_ being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract)above named, (S)he is the (C n ractor,Agent,Corpo ate 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/her knowledge and belief,and that the work will be performed in the manner set forth in the application file therewith. Sworn before me this � 1\ ay of ZD Notary Public PROPERTY OWNER AUTHORIZATION (Where the applicant is not the owner) 1 Nathan Brzozowski residing at 265 Union Ave, Belleville, NJ 07109 do hereby authorize Mark K. Schwartz to apply on my behalf to the Town of Southold Building Department for approval as described herein. Digitally signed by Nathan Nathan Brzozowski Brzozowski 5/7/2025 Date:2025.05.07 11:54:41-04'00' Owner's Signature Date Nathan Brzozowski Print Owner's Name 2 VML s ` OR Nk x ZZ — . �^ _ � � 4 BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PERMIT NO. 10763 DATE: APRIL 16,2025 ISSUED TO: NATHAN DRZOZOWSKI s PROPERTY ADDRESS: 34460 ROUTE 25. CUTCHOCUE s ; I SCTM# 1000-97-2-9.1 AUTHORIZATION Pursuant to the provisions of Chapter 275 of the Town Code of the Town of Southold and in accordance with the Resolution of the Board of Trustees adopted at the meeting held on April 1025, and in _ consideration of application fee in the sum of$1,251 ,00 paid by NA T RAN BRZOZOWSKI,and subject to the Terms and Conditions as stated in the Resolution, the Southold Town Board of Trustees authorizes and permits �. the following: Wetland Permit to demolish existing foundation and stair remains; construct a new two-story, single-family dwelling with attached garage (2,422.9sq.ft. footprint) with an 86sq.ft. northwest landing with stairs, a 15sq.ft. northwest landing with stairs,a 12sq.ft. northeast landing with stairs, an 80sq.ft. breezeway; a 234.7sq.ft. second floor balcony; a 16sq.ft. outdoor shower; a _ 560.3sq.ft. raised patio with 30.2sq.ft. stairs; 42.2sq.ft. bilco cellar entrance; 25sq.ft. A/C unit , area; an 18'x36' pool; on-grade 3,659sq.ft. pool patio surround with 36sq.ft. outdoor kitchenIF and 100sq.ft.spa/hot tub; install pool enclosure fencing with gates, pool equipment area, pool drywell; install an FA septic system; install an 8.000sq.ft. driveway for the dwelling; install a � � 60'x40' pole barn with a 3,500sq.ft. driveway, existing 498sq.ft. concrete pad to remain; install gutters to leaders to drywells to contain roof runoff; approx.. 1,645 cubic yards of excavation _ f and 1,165 cubic yards of fill for the project, the excess fill will be removed from the site; remove three(3) trees and the replace with six (6)3" caliper native hardwood trees; and to establish and perpetually maintain a 15' wide non-turf, non-fertilization vegetated buffer along the landward edge of lawn; with the condition to establish and perpetually maintain a non- disturbance buffer seaward of the line that was drawn 15' from the edge of lawn; and a one-to- 1 one replacement for any trees removed with native hardwoods of a.2"-3" caliper; all as depicted on the site plan prepared by Mark Schwartz& Associates, received on April 21, 2025, and stamped approved on April 21,2025. IN WTTNESS WHEREOF,the said Board of Trustees hereby causes its Corporate Seal to be affixed, l and these presents to be subscribed by a majority of the said Board as of the day and year written above. s d � z tl�ooly° Absent - � J11 - _ Is NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Facility DEC ID 1-4738-04650 PERMIT Under the Environmental Conservation Law CL Permittee and Facility Information Permit Issued To: Facility: NATHAN BRZOZOWSKI BRZOZOWSKI PROPERTY 265 UNION AVE 34460 MAIN RD11000-97-2-9.1 BELLEVILLE,NJ 07109 CUTCHOGUE;NY 11935 Facility Application Contact: TWIN FORKS PERMITS LLC 288 E MONTAUK HWY HAMPTON BAYS,NY 11946 (631)644-5998 Facility Location: in SOUTHOLD in SUFFOLK COUNTY Facility Principal Reference Point: N -E: 71.2.44 . :N: 4544.58 Latitude: 41°01'29,1" Longitude: 72028'23.4" Project Location: 34460 MainRd,Cutchogue SCTM# 1 -97-2-9.1 Waterbody SO-7 Authorized Activity: Construction of a single family dwelling and appurtenances,installation of an I/A OWTS.All work to be clone according to the plans preparedby Jwon Alan Ponti ri,last reed 4/1/2025 and stamped NYSDEC approved on 5/7/2025. (VAR) Permit Authorizations Freshwater Wetlands-Under Article 24 Permit ID 1-4738-04650/00002 New Permit Effective Date: 5/7/2025 Expiration Date: 5/6/2030 Tidal Wetlands-Under Article 25 Permit ID 1-4738-04650/00003 New Permit Effective Date: 5/7/2025 Expiration Date: 5/6/2030 Page 1 of 6 a NEW PORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION ROW Facility DEC M 14738-04650 NYSDEC Approval By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance with the ECL,all applicable regulations,and all conditions included as part of this permit. Permit Administrator:MARY A MACKINNON,DEPUTY REGIONAL PERMIT ADMINISTRATOR Address: NYSDEC Region 1 Headquarters SUNY @ Stony BrookJ50 Circle Rd Stony Brook,NY 11790 -3409 Authorized Signature: Date ` Distribution List TWIN FORDS PERMITS LLC Bureau of Marine Habitat Protection Habitat Wildlife File Permit Components NATURAL RESOURCE PERMIT CONDITIONS GENERAL CONDITIONS,APPLY TO ALL AUTHORIZED PERMITS NOTIFICATION OF OTHER PERMME OBLIGATIONS NATU10L RESOURCE PERMIT COND TZAL Apply to the Following Permits: FRESHWATER WE'LL S 1. PostPermitSign, The permit sign enclosed with this permit shall be posted in a conspicuous location on the worksite and adequately protected from the weather. Conformance With Plans All activities authorized by this permit must be in strict conformance with the approved plans submitted by the applicant or applicant's,agent as part of the permit application. Such approved plans were prepared by Jason Alan Pontieri,last revised /1/2025 and stamped NYSDEC approved 5/7/2025. Page 2 of 6 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Facility DEC ID 1-4738-04650 3. Notice of Commencement At least 48 hours prior to commencement of the project,the permittee and contractor shall sign and return the top portion of the enclosed notification form certifying that they are y awe of and understand all terms and conditions of this permit. Within 30 days of completion of project,the bottom portion of the form must also be signed and returned,along with photographs of the completed work. 4. Tree Clearing Prohibition for Long-eared Bats Due to the proximity of a known northern long- eared bat summer Occurrence,tree clearing is prohibited between March 1 and November 30.inclusive,of any calendar year. 5. Work Area Limits Any work,disturbance, and or storage of construction materials shall be confined to within the limit of clearing and ground disturbance shown on the approved plan. 6. Materials Disposed at Upland Site Any demolition debris,excess construction materials,and/or excess excavated materials shall be immediately and completely disposed of on an approved upland site more than 100 feet from any regulated freshwater wetland. These materials shall be suitably stabilized so as not to re-enter any water body,wetland,or wetland adjacent area. 7. Equipment Storage 100'from Wettand,Water Body All equipment and machinery shall be stored and safely contained greater than 100 feet landward of the regulated wetland or water y at the end of each work day. This will serve to avoid the inadvertent leakage of deleterious substances into the regulated area. a. Silt Screen Prior to commencement of any construction activities, a continuous line of silt screen (maximum opening size of U.S. Sieve#20)shall be staked along the LCGD line as shown on the approved plans. 9. Silt Screen to Be Recessed Silt screen shall be recessed six inches into the ground. 10. Maintain Silt Screen The screen shall be maintained,repaired and replaced as often as necessary_ to ensure proper function,until all disturbed areas are permanently vegetated. Sediments tapped by the screen shall be removed to an approved upland location before the screw is removed. 11. Runoff and Discharges Directed to Drywells All roof runoff and/or pool discharges shall be directed to drywells located as shown on the approved plans. 12. Driveway of Permeable Material The driveway must be surfaced with a permeable material. 13. No Pool Discharges to Wetland or Buffer There shall be no draining of swimming pool water directly or indirectly into wetlands or protected buffer areas. 14. Seed,Mulch Disturbed Areas All areas of soil disturbance resulting m prof shall be seeded with an appropriate perennial grass,and mulchedwith straw immediately upon completion of the project,within two days of final grading, or by the expiration of the permit,whichever is first. 15. Temporary Mulch,Final Seeding If seeding is impracticable due to the time of year,a temporary nulch shall be applied.and final seeding shall be performed at the earliest opportunity when weather conditions favor germination and growth but not more than six months after project completion. Page 3 of 6 in NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION 'ROW Facility DEC ID 14738-04650 16. Minimum %Vegetative Cover Suitable vegetative cover is defined as a minimum of 85 %area vegetative cover with contiguous unvegetated areas no larger than 1 square foot in size. 17. Notice Covenant The permittee shall incorporate the attached Covenant(or similar Department- approved language)to the deed for the property where the project will be conducted and file it with the Clerk of SUFFOLK County within 30 days of the effective date of 't. This deed covenant shall run with the land into perpetuity. A copy of the covenanted deed or other acceptable proof of record, along with the number assigned to this permit, shall be submitted within 90 days of the effective date of this permit to Regional Habitat Manager NYSDEC Region 1 Headquarters SUNY @ Stony BrookJ50 Circle Rd Stony Brook,NY11790-3409 is. Precautions Against Contamination of Waters All necessary precautions shall be taken to preclude contamination of any wettand or waterway by suspended solids,sediments,fuels,solvents, lubricants,epoxy coatings,paints,concrete, leachate or any other environmentally deleterious materials associated with the project. is. State May Order Removal or Alteration of Work If future operations by the State of New York require an alteration in the position of the structure or work herein authorized,or i ,in the opinion of the Department of Environmental Conservation it shall,cause unreasonable obstruction to the free navigation of said waters or flood flows or endanger the health,safety or welfare of the people of the State,or, cause loss or destruction of the natural resources of the State,the owner may be ordered by the Department to remove or alter the structural work,obstructions,or hazards caused thereby without expense to the State, and if,upon the expiration or revocation of this permit,the structure,fill,excavation,or other modification of the watercourse hereby authorized not be completed,the owners,shall,without expense to the State,and to such extent and in such time and manner as the Department of Environmental Conservation may require,remove all or any portion of the uncompleted structure or fill and restore to its former condition the navigable and flood capacity of the watercourse. No claim shall be made against the State of New York on account of any such removal or alteration. 20. State May Require Site Restoration If upon the expiration or revocation of this permit,the projecty authorized has not been completed,the applicant shall,without expense to the State, and o such extent and in such time and manner as the Department of Environmental Conservation may lawfully require,remove all or any portion of the uncompleted structure or fill and restore the site to its former condition. No claim shall be made against the State of New York on account of any such removal or alteration. 21. State Not Liable for Damage The State of New York shall in no case be liable for any damage or injury to the structure or work herein authorized which may be caused by or result from future operations undertaken by the State for the conservation or improvement of navigation,or for other purposes, and no claim or right to compensation shall accrue from any such damage. Page 4 of 6 As NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Facility DEC ID 1-4738-04650 GENIERAL CONDITIONS - Apply to ALL Authorized Permits: 1. Facility Inspection by The Department The permitted site or facility,including relevant records,is subject to inspection at reasonable hours and intervals by an authorized representative of the Department of Environmental Conservation(the Department)to determine whether the permittee is complying with this permit and the ECL. Such representative may order the work suspended pursuant to ECL 71-0301 and SAPA 401(3). The permittee shall_provide a person to accompany the Department's representative during an inspection to the permit area when requested by the Department. A copy of this permit,including all referenced maps,drawings and special conditions,must be available for inspection by the Department at all times at the project site or facility. Failure to produce a copy of the permit upon request by a Department representative is a violation of this permit. 2. Relationship of this Permit to Other Department Orders and Determinations Unless expressly provided for by the Department, issuance of this permit does not modify,supersede or rescind any order or determination previously issued by the Department or any of the terms,conditions or requirements contained in such order or determination. 3. Applications For Permit Renewals,Modifications or Transfers The permittee` must submit a separate written application to the Department for permit renewal,modification or transfer of this perFitt Such application must include any forms or supplemental information the Department requires. Any renewal,modification or transfer granted by the Department must be in writing. Submission of applications for permit renewal,modification or transfer are to be submitted to: Regional Permit Administrator NYSDEC Region 1 Headquarters SUNY @ Stony Brooki50 Circle Rd Stony Brook,NY11790 -3409 4. Submission of Renewal Application The permittee must submit a renewal application at least 30 days before permit expiration for the following permit authorizations:dons: Freshwater Wetlands,Tidal Wetlands. 5. Permit Modifications,Suspensions and Revocations by the Department The Department reserves the right to exercise all available authority to modify,send or revoke Ns permit. The grounds for modification, suspension or revocation include: a. materially false or inaccurate statements in the permit application or supporting papers; b. failure by the permittee to comply with any terms or conditions of the permit; c. exceeding the scope of the project as described in the permit application; Page 5 of 6 Am NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Sr Facility DEC ID 1-4738-04650 d. newly discovered material information or a material,change in environmental conditions,relevant technology or applicable law or regulations since the issuance of the existing permit; e. noncompliance with previously issued permit conditions,orders of the commissioner,any provisions of the Environmental Conservation Law or regulations of the Department related to the permitted activity. 6. Permit Transfer Permits are transferrable unless specifically prohibited by statute,regulation or other permit condition. applications for permit trarisfer should be submitted prior to actual transfer of ownership. NOTIFICATION OF OTHER PERMITTEE OBLIGATIONS It A:Permittee Accepts Legal Responsibility and Agrees to Indemnification The permittee,excepting state or federal agencies,expressly agrees to mdemnify and hold harmless the Department of Environmental Conservation of the State of New York,its representatives,employ and is("DEC")for all claims,suits,actions,and damages,to the extent attribiftable to the permittee's acts or omissions in connection with the p 's undertaking of activities in connection with,or operation and maintenance of,the facility or facilities authorized by the permit whether in compliance or not in compliance with the terms and conditions of the permit. This indemnification does not extend to any claims, suits,actions, or damages to the extent attributable to DEC's own negligent or intentional acts or omissions,or to any claims, suits,or actions naming the DEC and arising under Article 78 of the New York Civil Practice Laws and Rules or any citizen suit or civil rights provision under federal or state laws. - Item B:Permittee's Contractors to Comply with Permit The permittee is responsible for informing its independent contractors, employees, agents and assigns of their responsibility to comply with this permit,including all special conditions while acting as the pe _' 's agent with respect to the permitted activiues,and such persons shall be subject to the same sanctions for viol `ons of the Environmental Conservation Law as those prescribed for the permittee. It C:Permittee Responsible for Obtaining Other Required Permits The permittee is responsible for obtaining any other permits, approvals,lands,easements and rights-of- way that may be required to carry out the activities that are authorized by this permit. Item D:No Right to Trespass or Interfere with Riparian Rights This permit does not convey to the permittec any right to ftespass upon the lands or interfere with the riparian.rights of others in order to perform the permitted work nor does it authorize the impairment of any rights,title, or interest in Teal or personal property held or vested in a person not a party to the permit. Page 6 of 6 NOTICE COVENANT TO DEED DECLARATION THIS DECLARATION,dated day of , 201`, is made by (hereinafter the "Declarant"),whose address is WITNESSETH WHEREAS,the Declarant is the owner of certain real property located m the Town of`Southold, County of Suffolk, State Iof New York,Tax Map#District 1000,Section 97, Mc 2, Lot(s)9.001 which real property is more particularly described in Exhibit A annexed hereto(,hereinafter re d to as the : "Property");and WHEREAS,the Property is situated in or adjacent to regulated freshwater wetland SO- ofhe Southold Quadrangle which has been inventoried and map by the New York S Department of Environmental Conservation(hereinafter"Department'),pursuant to Environmental Conservation Law (hereinafter"ECL")Article 24(als6 known as the zFreshwater WetlandsAct")and Part 664 of Title b of the New York Code of Rules and Regulations(hereinafter"6 NYCW); and WHEREAS,various aactivities conducted both in and adjacent to _freshwater wetlands are regulated by the Department pursuant to ECL Article 24 and fart 31 of 6 NYCRR and rare written authorization from the Department prior to being conducted; NOW,THERE-FORE,in recognition of the Department's jurisdiction as set forth above,it is the responsibility of a party having any right,title,or interest in the Property,to obtain from the Department or any successor organization,a current description of all activities which are regulated pursuant to ECL Article 24 and Part 663 of 6 NYCRR,and to obtain written authorization from the Department prior to such regulated activities being conducted on the Property. Regulated activities include,but are not limited to clearing cif vegetation,application of chemi s ex vation; d l ` d erection of y structures. By: STATE OF NEW YORK ) COUNTY OF ) Qn the day of in the 1_ ,before me,the undersigned,a No lic in and for said state,personally appeared personally o to me or proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrurnent and acknowledged to one that he executed the same in his capacity, and that by his signature on the instrument,the person or entity upon behalf ofwhich the-person acted, executed the instrument. NOTARY PUBLIC Department of T TIC Environmental Conservation NOTICE The Department of Environmental Conservation (DEC) has issued permit(s) pursuant to the Environmental Conservation Law for work being conducted at this site. For further information regarding the nature and extent of work approved and any Departmental conditions on it, contact the Regional Permit Administrator listed below. Please refer to the permit number shown when contacting the DEC. Regional Permit Administrator SHERRI AICHER Permit Number: 1-4738-04650/00002 NYSDEC Region 1 Environmental Permits 50 Circle Road Stony Brook, NY 11790-3409 Expiration Date: 5/6/2030 Email: dep.rl@dec.ny.gov Note: This notice is NOT a permit ,7r Albert J. Krupskl, Jr. C IM \OVA\T)ER SUPERVISOR ( §4 N` \G]EM)EN1C' SOUTHOLD TOWN HALL-P.O.Box 1179 5 }],, 53095 Main Road-SOUTHOLD,NEW YORK 11971 Toi of Southold l CHAPTER 236 - STORMWATER MANAGEMENT REFERRAL FORM ( APPLICANT INFORMATION TO BE COMPLETED BY THE APPLICANT ONLY FOR PROPERTIES ONE ACRE IN AREA OR LARGER. ) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - APPLICANT: (Property Owner, Design Professional, Agent, Contractor, Other) NAME: �` .�- Date: (Prini) Contact Information: .3 (E-Mail&Telephone Number) Property Address / Location of Construction Site: Z � S.C.T.M. #: 1000 34- �a District —� Soon Block Lot TO BE COMPLETED BY SOUTHOLD TOWN ENGINEERING DEPARTMENT - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Area of Disturbance is less than 1 Acre. No S.P.D.E.S. Permit is Required ! Project does Not Discharge to Waters of the State. No S.P.D.E.S. Permit is Required! - Area of Disturbance is Greater than 1 Acre & Storm-water Runoff Discharges Directly to Waters of the State of New York. THE APPLICANT MUST OBTAIN a S.P.D.E.S. Permit DIRECTLY From N.Y.S. D.E.C. Prior to Issuance of a Building Permit. ❑ - Area of Disturbance is Greater than 1 Acre&Storm-water Runoff Flows Through Southold Town's MS4 Systems to Waters of the State of New York. THE APPLICANT MUST OBTAIN a S.P.D.E.S. Permit through the Southold Town Engineering Department Prior to Issuance of a Building Permit. 774�Reviewed By: Date: FORM * SMCP-TOS December 2024 9 ecety Cal v Cn C CD III O f „ Ou " Z z . C MATCH LINE ,w (see DETAIL 7) a -OEM CONTINUATION ,. 0 = O O 00 � n C O „ 1 /� / 1 A 0 T W 0 m o z /—�J O V�l I S I""I ..�.. — m �.........._ M. .....-. .... _..,__ .-. rn Ct!®Il t� O mm � � z m C7 SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES � -0 D* � 0 0 PERMIT FOR APPROVAL CIF CONSTRUCTION FOR A m u M .. SINGLE FAMILY RESIDENCE AND ¢' Accessory Barn (0 Bedrooms) �g ENGINEERS CERI IFICATION REQUIRED C DATE 28/2025 }-I_S Rw R-25 0208 SUBMIT FI.E. OR R.A. CERTIFICATION /APPROVED �.....�_ . REF, __...-..-� � ............ ..... - - -- -.-. - FOR INSTALLATION AND CONSTRUCTION TOTAL MXXIMUM BF ' Od:w " 5 _....w..... OF IA/OWTS + pump EXPIRES THREE YEARS FROM DATE OF APPROVAL _. �.. . _ ....��._. . _._.,. ..- ..... . _.. .. ...._. _mm .. FOR FINALAaPPROVAL. USE FORM M-073. n cN') D � m z rn v m D � ° a 0 � co CO) z z z , ...� Cf) M L �m 03 m C a 0 �' ;° c C > m oo to D M . fv N y = T I p G IT M � � 00 O z CD s � ry 0 n i G n M 01 O 0 ND z z o � �n 0 01 r, 71 �.., 34460 - " 7, _.: __,. 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