HomeMy WebLinkAbout33343-z
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
110: Z-32723
Date: 11/13/07
THIS CERTIFIES that the building ADDITIONS/ALTERATIONS
Location of Property: 1765
(HOUSE NO.)
COUnty Tax Map 110. 473889 Section 107
WESTVIEW DR
(STREET)
Block 7
MATTITUCK
(HAMLET)
Lot 7
SUbdivision
Filed Map 110.
Lot 110.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated
AUGUST 20, 2007 pursuant to which
Building Pennit 110. 33343-Z
dated
AUGUST 23, 2007
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
ADDITIONS & ALTERATIONS TO AN EXISTING SINGLE FAMILY DWELLING AS
I:
APPLIED FOR.
The certificate is issued to ERNEST A & ANN GAEBEL
(OWNER)
of the aforesaid building.
SUFFOLK COw... I' DEPARTMENT OF HEALTH APPROVAL
N/A
ELECTRICAL CERTIFICATE Il1O.
119227C
11/02/07
PLUMBERS CERTIFICATION DATED
N/A
~$4-
Authorized Signature
Rev. 1/81
,
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B=g~:y:'~JU[~ · ;~}~
TOWN BALL I C, "
765-1802 I___'m"l "HO:') I
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APPLICATION FOR CERTlFICATE OF OCCUPANCY
This application must be filled in by typewriter or ink and submitted to the Building Department with the following:
A. For new building or new use:
I. Final survey of prop~y 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 % 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 Apri19, 1957) non-conforming uses, or buildings and "pre-existing" land uses:
I. Accurate survey of property showing all property lines, streets, building and unllsual natural or topographic
features. "
2. A properlY completed application and consent to inspect sigoed by the applicmit. Ih Certificate of Occupancy is
denied, the Building Inspector shall state the reasons therefor in writing to the ~PIllieant.
C. Fees
I. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00,
Swimming pool $25.00, Accessory building $25.00, Additions to accessory buildip,g$25.00, Businesses $50.00.
2. Certificate of Occupancy on Pre-existing Building - $100.00 . "
3. Copy of Certificate of Occupancy - $.25
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date.
/1//~'1/~ 7
.
New Construction: /
11 1)TJ ';J,.. N
Old or Pre-existing Building:
(check one)
M .sn..7\..... c.-Ic.. N. >/,
Hamlet
L . fP J:Z" .:-
ocation 0 roperty: _ _ u ~
House No.
\..</ IS s"7v l6 ..c/ \> A..
Street
Owner or Owners of Property: ~ It ~ G <rl ~ po..... N.
Suffolk County Tax Map No 1000, Section I" 7
i
(j t:>o et.. ISL .
Block
06""7
Subdivision
-
Filed Map.
&' /';1.3 / " 7 Applicant: L,.s '"
Permit No. 33 :3 '4 ~ ~ Date of Permit.
Health Dept. Approval: N A
Planning Board Approval: IV A
Request for: Temporary Certificate
Fee Submitted: $ ;J S. tI) 0
Underwriters Approval:
Final Certificate: /"
( check one)
'f~~~
Applicant Sigo e
fuv .,,;%/
Co-c3,;21~.3
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.
33343 Z
Date AUGUST
23, 2007
permission is hereby granted to:
ERNEST A & WF GAEBEL
1765 WESTVIEW DR
MATTITUCK,NY 11952
for :
ADDITIONS AND ALTERATIONS TO AN EXISTING SINGLE FAMILY DWELLING AS
APPLIED FOR
at premises located at
1765 WESTVIEW DR
MATT I TUCK
County Tax Map No. 473889 Section 107
Block 0007
Lot No. 007
pursuant to application dated AUGUST 20, 2007 and approved by the
Fee $
850.00
Building Inspector to expire on FEBRUARY 23, 2009.
ORIGINAL
Rev. 5/8/02
I
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TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING I STRAPPING p(FINAL
[ ] FIREPLACE & CHIMNEY [] FIRE SAFETY INSPEcnON
[ ] ARE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENEmA110N
REMARKS: ~ ~
o I< -,
, 'w: OK
DA~~~.
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3}}f3L
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST
[ ] FOUNDATION 2ND
[ ] FRAMING I STRAPPING
[ ] FIREPLACE & CHIMNEY
[ ] RRE RESISTANT CONS1RUCTION
[ ] ROUGH PLBG.
rD(INSULATION
[ ] FINAL
[ ] FIRE SAFETY INSPECTION
[ ] RRE RESISTANT PENETRATION
REMARKS:~ ~
f: 0 1< ~
~~ ~~O*
--t::tr ~ ~
DATE
IO-/~o7
INSPECTOR
/A~
J'}3i3 Z-
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST
[ ] FOUNDATION 2ND
[ ] FRAMING I STRAPPING
[ ] FIREPLACE & CHIMNEY
[ ] RRE RESISTANT CONS'IRUCTION
REMARKS:
[ ] ROUGH PLBG.
~ INSULATION
[ ] FINAL
[ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT PENETRATION
--
~
~~
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DATE
7---71'-07
INSPECTOR ~~
c.". ~
333+3 Z-
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST
[ ] FOUNDATION 2ND
[ ] FRAMING I STRAPPING
[ ] FIREPLACE & CHIMNEY
[ ] RRE RESISTANT CONS11IUCTION
REMARKS:
()
/I f d-o /j-M.
[ ] ROUGH PLBG.
rP(INSULATION
[ ] FINAL
[ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT PENETRATION
~
DATE
7'-r7~ 07
INSPECTOR ~ ~
.-;-."~ -
333 )C3't-
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TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST [
[ ] ~DATION 2ND [
vJ FRAMING I STRAPPING [
[ ] FIREPLACE & CHIMNEY [
[ ] FIRE RESISTANT CONS1RUCTION [
REMARKS:
"
] ROUGH PLBG.
] INSULATION
] FINAL
] FIRE SAFETY INSPECTION
] FIRE RESISTANT PENE1RATION
~ ~~
DATE 9j1J-/C;?
! I
INSPECTOR
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.
, FIELD INSPECTION REPORT DATE I COMMENTS
~~
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: FOUNDATION (1ST)
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FOUNDATION (2ND) ~~
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ROUGH FRAMING & V\~
PLUMBING f
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INSULATION PER N. Y. ".?J.
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STATE ENERGY CODE . ^ ..
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FINAL m..-.:. A ,T -:?-' / , t
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I~ ADDITIONAL COMMENTS (J)
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PERMIT NO. 3"~?:JlJ:5-6
BUILDING PERMIT APPLICATION CHECKLIST
Do you have or need the following, before applying?
Board of Health
4 sets of Building Plans ./'
Planning Board approval
Survey ./
~
Check
Septic Form
N.Y.S.D.E.C.
Trustees V-
Contact:
Mail to:
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUT!.IOLtl, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
www.northfork.netlSouthold/
'3/0/3
,20-4-
,20-1-
Examined
Approved
Disapproved alc
Expiration
,20_
Phone:
I .
irl
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-,._, 1
. ; I APPLICATION FOR BUILDING PERMIT
i Date gla,t>
L-. _ i j INSTRUCTIONS
", a. TO.. ~~p 'u;;~tio~ '~'0'1 'f b~ Lompletely filled in by typewriter or in ink and submitted to the Building Inspector with 4
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.
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.
f. Every building permit 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 permit 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 South old, 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.
~c
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AUG 2 0 " '7
i
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,20 fJ7
l, S.. c:......t<; l c.. u p.P
(Signsture of applicant or usme, if a corporation)" 7
q ;;u t"\l>io 1\0( R.:;::;' J(q~
?"~o,, ~.4"'t~Prt'l~.)/,M l{,/
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
G:::)\~ 't" i:!" . j> L- c.... 0 .=:LI>. f' ;:-;:., ~ .
Name of owner of premises ~ HN..a.... ~ ""~I;&~ Ca ~lE b~L
(As on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer
l... _ "-':;:~c;..;.. L..l:r... J ~ _ ? (4 G ~
(Name and title of corporate officer)
Builders License No.
Plumbers License No.
Electricians License No.
Other Trade's License No.
qq ~O \.l.c ~
7~.3 .p
3.:lc..J.31 e:.
1. Location ofland on which proposed work will be done:
II~S 'VJE.S7v \ ~o...../ "1>R..
House Number Street
\1 -""" - . L_
I:l.ll.'\"'~
Hamlet
N.Y
(lq5~
County Tax Map No. 1000 Section
Subdivision
/07
Block C> "')
Filed Map No.
.':;.,,'
~l'/.i"
Lot 0 7
'm".""
". '","
. - -.,,:,<.
(Name)
.,..~-- ...
___I.
1
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a Existing use and occupancy 0 ~ -;- ~ ... . (. -/ K ~ r , "i>,;. ... c. is ..
b. Intendeduseandoccupancy ~ t-l/i; ~"'n'L'"( ~a~.1)...t-tc...;;;;
'1
3. Nature of work (check which applicable): New Building
Repair Removal Demolition
Addition
Other Work
./
Alteration
4. Estimated Cost ;;; G:', PI/ "
/
(Description)
Fee
5. If dwelling, number of dwelling units
If garage, number of cars
(To be paid on filing this application)
Number of dwelling units on each floor
6. Ifbusiness, commercial or mixed occupancy, specify nature and extent of each type of use.
7. Dimensions of existing structures, if any: Front tf;).'
..--
Height Number of Stories .;;J.
Dimensions of same structure with alterations or additions: Front ~.;l..
Depth 3 <-- Height Number of Stories ~
Rear J./.;l I
Depth 3(.. ,
Rear '-1.;1.
8. Dimensions of entire new construction: Front
Height Number of Stories
7..- I ""'7.L-'
9. Size oflot: Front.j Rear /...1
Rear Depth
Depth /Sc'.J? 7
10. Date of Purchase
Name of Former Owner
II. Zone or use district in which premises are situated
12. Does proposed construction violate any zoning law, ordinance or regulation? YES_NO / ./
13. Will lot be re-graded? YES_NO V'" Will excess fill be removed from premises? YES_NO ~
't'\ """"t\.'T.. w (./r:-
14. Names ofOwnerofpremisesfRN";; (;AL,I..e;AddressI7t.~-l.vf?s"'h",~"'Phone No.;2 99 -S6f gl
Name of Architect :j, "'\ 'l> ~~ 1=- S .... T Address tt.'-rc-.I....CO k.. Phone No
NameofContractorL1S" "1"..7 CuRP. Address J.........i'sf....7 PhoneNo. 7~:J-'-fa.s-1
c. tSu...- '.kJ S - '+ '" .Q..
15 a. Is this property within 100 feet ofa tidal wetland or a freshwater wetland? *YESLNO _ L."a~.... L.1.so
* IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMi MAY BE REQUIRED.
b. Is this property within 300 feet of a tidal wetland? * YES NO _
* 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 )
L..._ ~~a. L,. 1>" JA.. ? j:L .:1-5" being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
(i)He is the c. , ~ ~ .. ;:-;: . R. -
(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.
Swo
209-
Y-.L. ';z::, tI
Signature of Applicant
BARBARA ANN RUDDER
Notary P"bUc, Stat. nl New Yode
!,'J.48SSe05
Qualit~.' ,., S:.I:;I~ Counl'f),,"0
Commission ~plres "prlll~
,I
The localions of wells and cesspools
shown hereon are from field observalions
and or from dolo oblained fram alha,,,.
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ANY A LrnrA TION (JR ADDITION TO T1fS SUR l1!'Y~1S A." TION '
OF SECTION 7ZOtI OF THE: NEW YC:Wl' STA TE: Q)UCA
EXCEPT AS PER SECTiON 78(>>-SLeDMSION I!. ALL
~~~~1.~[~7HS~~.~ -aF :~~J~!~
WHOSE SIGNA TI.JRE APPEARS HEREON.
ADDITIONALL Y TO COWL Y filTH $AI) LAW THE:~'. .r
ItIUST BE USED BY ANY AJiD ALL aAlW!'YQV:un.. Y'
OF ANOTHER SUR\IE"YQlf'S MAP. Tf1WS $UCH AS " AND
"BROUGHT- To-oA TE:" ARE NOT IN COIIUANCE filTH THIt .
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AKJ CONSTRUCTION OF SUJ$UlFACE '
lXSPOSAL SYSTEMS FOR SN6LE FAIL Y 'S
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SURVEY OF
PROPERTY
A r AlA TTITUCK
__ TOWN Of SOUTHOLD
" SUFFOLK COUNTY, N. r:
o 1DDO- 707- 07- 07
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APR ? R 1995 ~I
TOWN OF SOUTHOLD
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ELEVA TlONS AND CONTOUR LNES ARE.bl1,lIIliIiIIr&. 'l!V ~_._
TO N.G.V.DATUM. . ~ .....rnvn....
'-<'~':)'-
1/97/
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N. Y.S. LIC. NO. 49618
ARIE"A = 7R.OD7 sq. ft. to tie !intis
':t5ItJl
P:"o.
/;lAM ROAD
SOUTHOLD, N. Y.
reST HOLE BY OTHERS
'-',
94-338
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,....,
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OWNER
IMP.
V
I -tiC
00 . ;;- ~300
00 1100
AGE
NEW
FARM
NORMAL
Acre
Tillable 1
Tillable 2
Tillable 3
Woodland.
Swampland
Brushland
Hause Plat
Total
-
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.
TOWN OF SOUTHOLD PROPERTY RECORD CARD
STREET 5" VILLAGE DIST. SUB.
I tf be.s
. ACR.//
.
- /4
LOT
V ~71/l.J () <-
EW;;:r~~
TYPE OF BUILDING
r::::.
/-rnF
--#fi-.
FARM
COMMi CB. MISC. Mkt. Value
REMARKS
TOTAL
DATE
. BELOW
ABOVE
Value Per
Acre
Value
/
FRONTAGE ON WATER
FRONTAGE ON ROAD
DEPTH
BULKHEAD
,-
~O
~ ~,
~
.--
DOCK
- ~ -
Extension
3 S '" 30 " /0 S""D
)',O'/z-;,:> /20
13 "12..': / 5
COLOR
Jo
"ff- u-n'" 1-
r a ...... Po c.t! .t
TRIM ,\ 13
40 I' ~ t
. ,.
,
,.
"-
h.OO ~300 Foundotion PL Bath Dinette
1.0 Bosement f...,11 Floors .I", IJrc... K.
~-
3.$"0 546 Ext. Walls /l.... Interior Finish LR.
Fire Place t/e.s Heot D. DR.
Type Roof Rooms 1 st Floor BR.
,!"'o 5 Recreation Room Rooms 2nd Floor FIN. B.
Dormer
f"o {,/IO Driveway
5/16
M~___..
I M. Bldg.
I
Extension
Extension
Breezeway
o >- /12-
Porch
~Id;-
/:'3'1
Garage
Patio
/6,12-2...;0 3r
::>2-
.z,-
-:,por
'1'to
:z 00
A
G. F;,.
Total
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James F. King, President
Jill M. Doherty, Vice-President
Peggy A. Dickerson
Dave Bergen
Bob Ghosio, Jr.
Town Hall
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
August 10, 2007
Mr. & Mrs. "Ernest Gaebel
1765 Westview Drive
Mattituck, NY 11952
RE: 1765 WESTVIEW DRIVE
SCTM# 107-7.7
Dear Mr. & Mrs. Gaebel:
The Southold Town Board of Trustees reviewed the survey prepared by Peconic
Surveyors, last dated April 27,1995 and received on August 7,2007, and determined
the proposed work of raising the roof to add a walk-in closet to the northern side of the
front of the dwelling to be out of the Wetland jurisdiction under Chapter 275 of the Town
Wetland Code and Chapter 111 of the Town Code.
Therefore, in accordance with the current Wetlands Code (Chapter 275) and the
Coastal Erosion Hazard Area (Chapter 111) no permit is required. Please be advised,
however, that no construction, sedimentation, or disturbance of any kind may take place
seaward of the tidal and/or freshwater wetlands jurisdictional boundary or seaward of
the coastal erosion hazard area as indicated above, or within 100' landward from the
top of the bluff, without further authorization from the Southold Town Board of Trustees
pursuant to Chapter 275 and/or Chapter 111 of the Town Code. It is your responsibility
to ensure that all necessary precautions are taken to prevent any sedimentation or other
alteration or disturbance to the ground surface or vegetation within Tidal Wetlands
jurisdiction and Coastal Erosion Hazard Area, which may result from your project. Such
precautions may include maintaining adequate work area between the tidal wetland
jurisdictional boundary and the coastal erosion hazard area and your project or erecting
a temporary fence, barrier, or hay bale berm.
This determination is not a determination from any other agency.
I.
T
..-'
2
If you have any further questions, please do not hesitate to call.
Sincerely,
J8};:9;.2
Board of Trustees
JFK:eac
Town of Southold
Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM
PROPERTY LOCATION: S.C.T.M. #:
lu/) 107 07 07
DiSiriCI ~ BiOCk ---.::c;r-
THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A
STORM-WATER, GRADING, DRAINAGE AND EROSION CONTROL PLAN
CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK.
Item Number: (NOTE: A Check Mark ( l) for each Question Is Required for a Complete Application)
----------------------------------------------------
No
Yes
-----------------------------------------------7---
1 Will tihls Project Retain All Storm-Water Run-Off Generated by a Two (2") Inch Rainfall on Site? n
(This item will Include all run-off created by site clearing and/or construction activities as well as all Site - l.:;;J
Improvements and the permanent creation of impervious surfaces.)
2
Does tihe Site Plan end/or Survey Show All Proposed Drainage Structures Indicating Size & Location?
This Item shall Include ell Proposed Grade Changes and Slopes Controlling Surface WaterFlowl
3
Will this Project Require any Land Filling, Grading or Excavation where there is a change to the Natural
Existing Grade Involving more than 200 Cubic Yards of Material within any Parcel?
4
Will this Application Require Land DistUrbing Activities Encompassing an Area in Excess of
Five Thousand (5.000) Square Feet of Ground Surface?
5
Is there a Natural Water Course Running through the Site?
Is this Project within the Trustees jurisdiction or within One Hundred (100') feet of a Wetland or Beach?
6
Will there be Site preparation on Existing Grade Slopes which Exceed Fifteen (15) feet of Vertical Rise to
One Hundred (100') of Horizontal Distance?
7
Will Driveways, Parking Areas or other Impervious Surfaces be Sloped to Direct Stonn-Water Run-Off
into and/or in the direction of a Town right-of-way?
8
Will this Project Require the Placement of Ma~erial, Removal of Vegetation and/or the Construction of
any Item Within the Town Right-of-Way or Road Shoulder Area?
(This Item will NOT Include the Installation of Driveway Aprons.)
9
Will this Project Require Site Preparation within the One Hundred (100) Year Floodplain of any Watercourse?
/[J
[di/
[J./
[d
[d
[d
[J
[d
NOTE: If Any Answer to Questions One through Nine Is Answered with a Check Mark In the Box, a Storm-Water, Grading,
Drainage & Erosion Control Plan Is Required and Must be Submitted for Review Prior to Issuance of Any Building Permit!
,/
./
,/
,/
./
EXEMPTION:
-------------------------------.---------------------
No
Does this project meet the minimum standards for classification as an Agricultural Project?
Note: If You Answered Yes to this Question, a Stonn~Water. Grading, Drainage & Erosion Control Plan Is NOT Requlredl
Yes
~
----------------------------------------------------
STATE OF NEW YORK,
COUNTY OF ........................................... SS
That I, .k~I!:.If..t!.fk..:,..../".L5..9.....J.&............. being duly sworn, de~oses and says that he/she is the applicant for Pennit,
(Name of individual signing Document)
- - ^
And that he/she is the .....~.~.~.~.!!:::~..~"~.~.~........................................................................................................................
(Owner, Contractor, Agent. Corporate Officer, etc.)
Owner and/or representative of the Owner of Owner's, 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 knowlemand belief; and
that the work will be penormed in the manner set forth in the application filed herewith. 8"116"11" "1I1111~.. York
Sworn to ber.~r me this; 110111'/ fu~\ie, ~~& .
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............. ............... ............ ay 0 .... COIIImllliOn E II np
Notary Public: ....................................................
FORM - 06/07
The loco/ions of wells and cesspools
sho wn hereon are from field observa/ions
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EXCCPT AS PCR seCTION ~ Z. AU. f1(I(W>
fEREON ARC VAW FOIl T#IS IIAP AND COPIES . Y F
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WST BE USE:/) BY ANY AND ALL &fM1I!'YCIlV UTI..
OF ANO nER Sl.R\lf:YOR'$ MAl'. TI1f1t/$!IUCH AS '0' AND
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SURVEY OF
PROPERTY
AT MA TTlTUCK
TOWN OF SOUTHOLD
SUFFOLK COUNTY, N Y:
1000-107- 07- 07
Scale: 1"= 30'
Oct 26, 1994
June 6, 1995 (foundation)
July 18,1996 (final0
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CERTIFIED TO'
ANN GABEL
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KEY MAP 10/29/94 re"'''n..
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PECON/C
(516) 765 -
P. O. BOX 9
MAIN ROAD
SOU THOL D, N. Y.
1/971
O. 496/8
94 -338
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