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HomeMy WebLinkAbout31165-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-31047 Date: 07/20/05 THIS CERTIFIES that the building DECK ADDITION Location of Property: 1400 HIAWATHAS PATH SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No_ 473869 Section 78 Block 3 Lot 48 Subdivision Filed Map No. Lot NO_ conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 16, 2005 pursuant to which Building Permit No. 31165-Z dated MAY 25, 2005 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 DECK ADDITION TO EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR & AS PER CONDITIONS OF ZBA 45663 DATED 5/12/05. The certificate is issued to DONALD J & SANDRA ANNINO (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Authorized Signature Rev. 1/81 • Form No.6 TORN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 ' It'X APPLICATION FOR CERTIFICATE OF OC'CUPAN �' 1,— . r it ll This application must be filled in by typewriter or in], and submitted to the Building Depa wrth the following: A. 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 I°"o 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"pre-existing" land uses: L Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and 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$25.00, Additions to dwelling$ZL.00. Alterations to dwelling$25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building$25.00, Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building- $100.00 3. Copy of Certificate of Occupaocy -$.25 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 New Construction: Old or Pre-existing Build ir g: (check one) / Location of Property: l House No. Stree Hamlet Owner or Owners of Property: Suffolk Countv Tax Map No 1000, Section �]� Block _ - Lot Subdivis"i rFiled Map. _ Lot: Permit Na Date of Permit.SZSU,7 ' :__ oval: Undenrriters Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ Applica ignatum QRc• � 8s3-5 cow >ID `0 FORM NO . 3 TOWN OF 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) PERMIT NO. 31165 Z Date MAY 25 , 2005 Permission is hereby granted to: DONALD J ANNINO 1400 HIAWATHA' S PATH SOUTHOLD,NY 11971 for CONSTRUCTION OF A DECK ADDITION TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR PER ZBA DECISION #5663 at premises located at 1400 HIAWATHAS PATH SOUTHOLD County Tax Map No. 473889 Section 078 Block 0003 Lot No. 048 pursuant to application dated MAY 16, 2005 and approved by the Building Inspector to expire on NOVEMBER 16 , 2006 . Fee $ 150 . 00 I Authorized Signature ORIGINAL Rev. 5/8/02 / APPEALS BOARD MEMBERS so Southold Town Hall �! Ruth D. Oliva. Chairwoman ,`4 1p 53095 Main Road•P.O. Box 1179 Gerard P. Goehringer Southold, NY 11971-0959 Vincent Orlando C, 2W Office Location: James Dinizio. Jr. • ,O Town Annex/First Floor,North Fork Bank Michael A. SimonOI�COO 54375 Main Road(at Youngs Avenue) Southold. NY 11971 http://southo[dtown.northfork.net BOARD OF APPEALS MAY 2 3 M _ TOWN OF SOUTHOLD L.__ _ J Tel. (631) 765-1809• Fax(631)765-9064 r L — F NEdI GS, DELIBERATIONS AND DETERMINATION MEETING OF MAY 12, 2005 ZB Ref. 5663 – Donald Annino Property Location: 1400 Hiawathas Path, Southold CTM 78-3-48 SEQRA DETERMINATION: The Zoning Board of Appeals has visited the property under consideration in this application and determines that this review falls under the Type II category of the State's List of Actions, without an adverse effect on the environment if the project is implemented as planned. PROPERTY FACTS/DESCRIPTION: The applicant's 22,276 sq. ft. parcel has 210.22 ft. frontage along the west side of Hiawatha's Path and 110 ft. lot depth, in Southold. The property is improved with a two-story frame dwelling with garage and accessory storage shed, as shown on the survey prepared by John C. Ehlers, L.S. dated 11-4-99, updated July 29, 2003. BASIS OF APPLICATION: Building Department's December 1, 2004 Notice of Disapproval, citing Section 100-244 in its denial of an application for a building permit to construct a proposed deck, for the reason that the new construct will be less than the code required 50 ft. setback. FINDINGS OF FACT The Zoning Board of Appeals held a public hearing on this application on May 4, 2005 at which time written and oral evidence were presented. Based upon all testimony, documentation, personal inspection of the property, and other evidence, the Zoning Board finds the following facts to be true and relevant: AREA VARIANCE RELIEF REQUESTED: The applicant wishes to construct a 12' x 21.7' deck addition at the rear of his dwelling, 30 feet from the property line at its closest point. The deck is proposed with railings, open to the sky (unenclosed, unroofed). REASONS FOR BOARD ACTION: On the basis of testimony presented, materials submitted and personal inspections, the Board makes the following findings: 1. Grant of the variance will not produce an undesirable change in the character of the neighborhood or a detriment to nearby properties. The new deck is proposed to be open and unroofed, deck for access. The deck will have railings and two stairways, and will be an extension from the back of the existing porch, which porch is 42 feet from the rear property line. Neighboring houses have similar deck construction. Page 2—May 12, 2005 ZB Ref. 5663—Donald Annino CTM ID: 78-3-48 2. The benefit sought by the applicant cannot be achieved by some method, feasible for the applicant to pursue, other than an area variance. 3. The variance granted herein is not substantial, in that the open, unroofed addition will consist only of an uncovered 12 ft. wide deck that will reduce the rear yard by a maximum of eight feet, for a rear yard setback at not less than 30 feet, at its closest point. 4. The difficulty was self-created in that the house has existed for many years, on a lot that is nearly 297.51 feet wide along the westerly property line and 109.26 feet deep along the northerly side property line. 5. No evidence has been submitted to suggest that a variance in this residential community will have an adverse impact on the physical or environmental conditions in the neighborhood. 6. Grant of the requested relief is the minimum action necessary and adequate to enable the applicant to enjoy the benefit of an open deck addition, while preserving and protecting the character of the neighborhood and the health, safety and welfare of the community. RESOLUTION OF THE BOARD: In considering all of the above factors and applying the balancing test under New York Town Law 267-13, motion was offered by Member Simon, seconded by Member Orlando, and duly carried, to GRANT the variance as applied for, as shown on the survey prepared by John C. Ehlers dated 11-4-99, updated July 29, 2003. This action does not authorize or condone any current or future use, setback or other feature of the subject property that may violate the Zoning Code, other than such uses, setbacks and other features as are expressly addressed in this action. Vote of the Board: Ayes: Members Oliva (Chairwoman), Orlando, Dinizio, and Simon. Absent was: Member Goehringer. This Resolution s duly adopted (4-1). Ruth D. Oliva, Chairwoman 5/ � I05 Approved for Filing 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1 ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ FINAL [ ] FIREPLACE & CHIMNEY Q[ ] FIRE SAFETY INSPECTION REMARKS: A-11 4&= 0 DATE 7- 13 - os INSPECTOR TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION �C FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS: \ pp aA-Q- o 6 DATE INSPECTOR FIELD INSPtCTION REPORT I DATE COMMENTS FOUNDATION (IST) L ? \ x -------------------------------------- CIT— - FOUNDATION(2ND) ---- - Z O ROUGH FRAMING& a PLUMBING D INSULATION PER N. Y. — — --- STATE ENERGY CODE FINAL, C- d ADDITIONAL COMMENTS Z Z - 2 G o z z �m A Z Q- 0 TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL Board of Health_ SOUTHOLD, NY 11971 4 sets of Building Plans_ TEL: (631) 765-1802 Planning Board approval FAX: (631) 765-9502 ]� V Surrey wniv, northfork.net/Southold/ PERMIT NO. ✓ Checker—#L—T. Septic Form N.Y.S.D.E.C. Trustees Examined —. 10 Contact: Approved , 20 Mail to: Disapproved a c Phone:_(p,5-_3 51J Expiration ,20 Building Inspector LIU v I B 20105 L. APPLICATION FOR BUILDING PERMIT i buJ6. DEP?. ___ Date 20 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 waterways. 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 issue a Building Permit to the applicant. Such a permit shall be kept on the premises available for inspection throughout the work. i e. No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector issues a Certificate of Occupancy. E Every building pennit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the property have been enacted in the interim, the Building Inspector may authorize, in writing, the extension of the pen-nit for an addition six months.Thereafter, a new permit shall be required. 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 authorized inspectors on premises and in building for necessary inspections. 11 � .cnd (Signature f a licant or name, if a corporation) C.Dly-1 V (Matlenjadcifess of p icant) / State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder 6V-f.4X1L Name of owner of premises / \7 ��1 [..f� �z• (As on the tax"ro�lo"r' latest deed) If applicant is a corporation, signature of duly authorized officer (Name and title of corporate officer) Builders License No. _ Plumbers License No. Electricians License No. Other Trade's License No. 1. Location of land on which propose w k 1 be d /�� i.4�,.;�-A t� 10el =7 ivy/ //97/ House Number ' Street �� I Hamlet County Tax Map No. 1000 Section Block J 1 Lot_ _ Subdivision Filed Map No. — Lot (Name) 2. State existing use and occupancy of premis andintended use and occupancy of proposed construction: a. Existing use and occupancy �Sj�/"/`f/»e, / b. Intended use and occupancy vv // 3. Nature of work (check which applicable): New Building Addition Pl e'44 Alteration Repair Removal Demolition Other Work (Description) 4. Estimated Cost Fee (To be paid on filing this application) 5. If dwelling, number of dwelling units Number of dwelling units on each floor If garage, number of cars 4 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front Rear ,y e z Depth 30CpP,.;'7 Height Number of Stories Z p i i Dimensions of same structure with alterations or additions: Front Rear 14/1 Depth ��� Height Number of Stories L ��8. Dimensions of entire new construction: Front Depth /Z Height Number of Stories 9. Size of lot: Front Zle)f Z L Rear 7•S"/ Depth > 10. Date of Purchase Name of Former Owner 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES X NO 13. Will lot be re-graded? YES NO-Will excess fill be removed from premis s?/SES X' NO �j4j�j. l��it't 14. Names of Owner of premises "' Address ' one�"No. -`1 Name of Architect Address Phone Name of Contractor Address C Phone No. 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES NO X * IF YES, D.E.C. PERMITS MAY BE REQUIRED. 16. Provide survey, to scale, with accurate foundation plan and distances to property lines. 17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey. STATE OF NEW YORK) SS: COUNTY OF ) being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract)above named, (S)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 set forth in the application filed therewith. Sworn to before me this dayof 6t) 192V 20O_ Vtuc Sr tur of pp r nt Stell d tNw Yak CueliHed In Suffolk County Commlsslon Expires May 29,200-7 SURVEY OF F'ROf=ERTY N SITUATE: LA;UCHINCG HATER TOWN: SOUTHOLD W E SUFFOLK COUNTY, NY SURVEYED II-4-QC, UPDATE 07-261-03 S SUFFOLK COUNTY TAX u 1000 - 78 - 3 - 48 CERTIFIED TO: 1 DONALD ANNINO 5ANDRA ANNINO PRINCIPAL RE51DENTIAL MORTGAGE, INC. ALL5TATE A05TRAGT CORP. #630527710-04 II Lond 0OV4 0WeoVhen y �r W Lynn Wench. d ,. II I 3,00„E 109.26'NS1 ➢r °1 aned 135 I� II J Q 3 o0 'I O W 3 I 0° J I s II. �I .20.3. � I zes iza' 3�� 42.0' c o- 0 -3 Os ON oopp ti 1 k (tion fir, N. N II I 1� J iA I^ G9'N arc v S87051'00"W 110.00' LL � 9f � c I O Lond r�cw or formerly of m c Torn Lindstrom Latko,'ic s hlilnom F. Steens ill J1 . 3 Of NEW u � G I '\ roa0 angle Gf � s .io la[icn � °c ne�2tory°State E°ucet den�ry NOTE5: .c°= ■ MONUMENT 1�C O� Y6;'d°a °I°.. . - O PIPE . . [... ... .u° .°°,[• °': AREA = 22,276 5F OR 0.51 ACRE5 LAND .eq[. _ _JO C. EHLERS LAND SURVEYOR 6 E�,T MAIN STREET N.Y.S. LIC. NO. 50202 GRAPHIC, SCALE 1"= 50' RIVERHEAD,N.Y. 11901 369-8288 Fax 369-8287 REF.-TIGER\PROS\99-268 . A� P�hT OT", CA RESISTANT CONSTRUCTION CONNECTORS INTRt1CTIN R�i CO ��LST`ANT C N . ` U NNE�TIQN I] as - 4' U � I" T . LT T R 44 .4 , 44 : Y R ziT/&QwbdN TO IRR A' T1 T 4ESEON RAFTER - HEADER T R1 1-^f/. © .. b@R60ARD TMU26 0 6NNEGY(SRS PSR • pRE91SfANT C41N$7R(11i0{-! ONLY �yV47i'1 : -•, LFOLLOWEMANlL1�ACNG OR 1URE 5'REGOQMFNDE'O-ttiSTALIA PROPER MIN �UPU - - _ AFTER TO USE -Y( yy-� INSTALLATION INSTRUCTIONS TQ ACHIIIEVE ktA/X.IM�Uy�*t�� F7,I;QAO CAPAOITY: 1E :, - NAII�Il�(G, SCHN�DWLE - HEADE C10t; F N R.AFfiE# NT� �: ��- ' .iOPFl11 1k0'��IW�� kii19�J . T I IIII tO�TOP. - 1 rALL f JM N - 8�. � F CSW OEWNS+ ,TRS AS11iT 'aJ SACH TY37fi°?AL: Fbth.CrE`'TO,RAFTFt.STRALaR1pd.G F'G R TO WA - OOI�INEC.TIOIV T RNATIV AFTER fi� 'H �'. CTIOM FAW,,JJ.EL glFfgN' LAP . NAb k OCCUP ',^U,`' OR c09 ASP�R. at' e u�,F I� �I, l:j na ASH44fiMk63A �1 PA E STAIR 'TREA TAFp GINAXX RDER/Y EAG?E t AR �I i KATE m z ; 008 10 PaSr RIS ao _ _ I 0!`,< STRINGEf — ` 4rr _ 'I ��_a NDISlf hf.M�/DECK JOIS n IIRTAIN ^—gMWATER RUNOFF , t4 . fataDMMati FA�Ei(IUL _ 4 }6l TO DEL C✓PORCH" ON C�TIOWPHI 03ECTION 45•tOC T 4-.i" � . lf.1f+ATTGR Tr,�P^ Tf :TMTI rr�n+ :;.ONNECTION - �` - - _ €ltTt ., "+N CODE. To fgdgoNMlQn. a.0 1MDE x' f4d,DDfNWI ' ' r`�RTIFICAT3N"OF TO DECK�fPORCH.-CONNECTION NA;l- -3 & CONNECTIGIJS z.,m* Fox � ' REQUIRED. . PER OMRtli4I'f147. x•13df:DIfMOM FTTo DECKJOISI FApEN7-A.' f . - _ J41R11''pEMCPoPi10M NOTO ` Gt�CI}€ R ,HE- : . ALL N , , �'}wT �, •- • ME - - N bE1,TOP fq,A7E�:2tfIRl12R x•adcoffaDN FaA$N'" ft f GIRDER'/HEADED ; '-� co WYo n ' .,,IE To f3 ro°H . s?C)�a T /C UL { JOIST x aDnNu?a,,, .OIR NUL POST/COLUMN---E> APPE,cDASNOTED 'w 1° ' ' wN " �.'S-_ B.P.3 �i Td* : 8 tOd cgMWpt7 '.10W-- 1NAIL GIRDER/HEAaE. DATE: JDx700 LEL1[i6R PER" TDE p� TceEnR+ a•fldDowton• x516T NAh. FEE: I�U.__w BY:.}.�. 0 - NOTIFY BL -i .3 DEPA"TMENT AT ffMCWf11DN kS IT' !Up ` 765-1802 L:,� TO 4 Ph' FOR THE FOLLOWIt, - a"SPECTIONS' SILLL TOPaAE "1M ROLWDH �' TOe NAIL 1. FOUIJ,-f ICN - TWO FEOUIRED " J41 T TO IRDER/HEADER C. EC .��pNCPETE NUL, 4", i FB.Lki :T2`TO PD TI 0 IMN ONN ,TION GIRDERJHFAD�R 7p7p T/m dLUMN fl, Nt TION �� 2. N, rR= 8 F_UMBINO �� " deo Not" .. ' . 3. INSLIL:,-i,JN ✓!1$IICTIbK PANEL .� Al PPR, '3E 4. FINAL - CONSTRUCTION MUST WFBRR BE COMPLETE FOR C.O. DECK DRC ALL CONSTRUCTION SHALL MEET'THE Y'ECK AND, �pvnVH �Q��' UIRMENTS OF THE CODES OF NEW f}UNnM� w�44+M�i _„_�,m�!1.f�fAOR PIN9 'w i . AlffhAllN� ri.y.w12411 dmbblNfl��n1MW�40 STATE. NOT RESPONSIBLE FOR - "I - - SI N OR CONSTRUCTION ERRORS. x}GYdfnkfAWiJoMbbbgiilefpgqlajypMio�plfpoiMagfrWb,w4Mrq mdn* .I slowmaeiFSMfiplNa'wo"wapehgrW rAhP�pw�4M.9am++aiep+nI , GLRD'ER 1� rrw.i^aift ' �n...d �!M 10a7TM12'M7x'NMkaaiclAnb4Wq• POST - or Flo a 'r • iw+'r. `a �MriM.,'3'4�iNwa.e�. ,. " . , WOOD JOTS' 6 4}DlfkkMbkAbr bbtldnp-1 y aS 6}AiNim�mW tObch3AMfex ffr6MIMfMlMhwun tln bWldNp ubfndpfr. �' COtJCR'ET� PIER —= GIRDER/HEAD o Uf� t4ab.rb"IatoNAMIMIM rbobwmwahmOWnuM 12 x12 x12 CONCRETE FOOT "" >•""' WOOD JO!S - aFlOpwp�PNnMY4f�mYtlmum6'nhowpWn. 7}MldW bbb*wow Wm baWMmd mclpraE�di J*M 00nlmbomAmmd : '>� :' DST TO FQQTING CONNECTION cof.na �r.abwn�.nw.d.bmd,nl.aw,..m.mlrvw.. JQIST"FRAMINQ EI,-USH WITH GIRDER/HfADER CLIMAT_ & GEOGRAPHIC DESIGN CRITERIA GIRDER TO CONCRETEP}ER' CONNECTION s°�NRUw� tMa 1i �D u A DVM MIIT TEUeRE DECAY D o UNDO YM2EN7 Flfx ' . - - MpOEgATE� TO 11 NONE + FF •^f L116. 1W p - -)KiIEA3 3FT. TOHF#W MO(fJMTE '41N STORM W ATER RUNo " I . tUANTTO SECTION � GODE. jr TOWN 1 Mer Joseph Fischetti, P 1725 Hubert Road - 5outhpld, NY 11571 631'': 5-2954 . n - " r i J, - I ! gri j' �tPO Pr H 14 'r44WC ?3411 IL f Ptl3'i2�. � -� I r,� � 'L> �'*" LI '? 4 i idlU' ^dk� h i, u, ji Al _ � 'b �h�(!? �:• t fie*x.12 -7 , - y �� ! � r, t � � ' 7- 7 fes, tr 71 P7�joF � L. �OF NEW }3C.rN F\ h �/ - SCALE 1 1 : r ONAWN Br m ARPRoveo ev. ,. ♦ { E lL oATE a.r I ,.- DRAWING NUMBER/%� .. -' � � � Applicant/ Date. . Owners Nwlw... -Reviewed: S- ate: ArchitecU Engineer:. -- Submitted: SCTM ft: pistrict: 1,400 Section: Block.: Loi: _ IIroject Subdivision'Name: / P s Location: 1/00 •f. � . _ _ _ • Si tt le d: separate Required cell Ifwation: (Yes i No) Req. Req• �ntting 1�islricl: _ (I of size: Acural: � 7 ( (Loc cuvcrasc �!( (.ritlxi.cd Req. (front Pard I'roposcd: l' (Side Yard i- o osed: 1 •jRear Yard _ Proposed,i Project Description: AG NOUBUM ILO`UIRED FOA REVIEW Y.A.. ISO YES Numbpr Sufblk County Health Dept. Now York State. D.E.C. Town Tntstees � Town Zoaing Board approval: _ f�� -- Town Pli d n Board approval: Flood.plaae Elevation M Flood Zone: _' '