HomeMy WebLinkAbout28151-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-33892 Date: 08/10/09
THIS CERTIFIES that the building DECK ADDITION
Location of Property: 1050 WATERVIEW DR SOUTHOLD
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No. 473889 Section 78 Block 7 Lot 27
Subdivision Filed Map No_ Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 6, 2002 pursuant to which
Building Permit No_ 28151-Z dated MARCH 8, 2002
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 REAR DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to MARK SCHILL & AMY WOODHULL
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
,-4 1�27 Z4�
/AZthorized ignature
Rev. 1/81
Form No.6
D E C E d TOWN OF SOUTHOLD
L5 t
D BUILDING DEPARTMENT 1 a s ;
TOWN HALL I
AUG s 2009 765-1802 �ut
BLDG.DEPT. A PLICATION FOR CERTIFICATE OF OCCUPANCY
TOWN OF SOUTHOLD
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: lines, streets, and unusual natural or
1. Final survey of property with accurate location of all buildings, property
topographic features. 1 and sewerage-disposal(S-9 form)-
2. Final Approval from Health Dept.from
water supply
3. Approval of electrical installation from Board of Fire Underwriters.
4. Swom statement from plumber certifying that the solder used in system contains less than tall of s, lead.
5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate
e for the
of Code Compliance from architect
cof complet d site plagineer requirements,
building.
6. Submit Planning Board Approval
riot to April 9, 1957)non-conforming uses, or buildings and"pre-existing" land uses:
B. For existing buildings(P
lines, streets,building and unusual natural or topographic
1. Accurate survey of property showing all property
feahu•es, the applicant. If a Certificate of Occupancy is
2. fe properly completed application and consent to inspect signed by
denied,the Building Inspector shall state the reasons therefor in writing to the applicant.
C. Fees New dwelling$25.00,Additions to dwelling$25.00, Alterations tBdwelling $50.0,
1. Certificate of Occupancy building$25.00, Additions to accessory g
Swimming pool$25.00,Accessory g
2. Certificate of occupancy on Pre-existing Building- $100.00
3. Copy of Certificate of occupancy-$25.00
4. Updated Certificate of occupancy- $50.00
5. Temporary Certificate of Occupancy-Residential$15.00,Commercial$15.00 I 3
Date. f/I S/ d
(check one)..
New Construction: e G Old or Pre-existing Building:
o S a w 4 tsn P w r 1 T ' ) gamlet
Location of Property: Street
House No.
Owner or Owners of Property: Mj
�Ig Block �L--
Suffolk County Tax Map No 1000,Section Filed Map. —Lot:
Subdivision Date of Permit. /—Applicant: 'V1 A R h S
permit No. �i .� LSI- (i a
Underwriters Approval:
Health Dept.Approval:
planning Board Approval: (check one)
o Certificate�—Final Certificate:
Request for: Temporary
Fee Submitted: $
L z 2-- -?;� Applicant Signature
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. 28151 Z Date MARCH 8 , 2002
Permission is hereby granted to:
MARK SCHILL
1050 WATERVIEW DR
SOUTHOLD,NY 11971
for
CONSTRUCTION OF A REAR DECK ADDITION AS APPLIED FOR WITH FLOOD
PERMIT
at premises located at 1050 WATERVIEW DR SOUTHOLD
County Tax Map No. 473889 Section 078 Block 0007 Lot No. 027
pursuant to application dated MARCH 6, 2002 and approved by the
Building Inspector.
Fee $ f� 250 . 00 0�
s 1000 at
Authorized Signature
ORIGINAL
Rev. 2/19/98
x/ 67
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSU ON
[ ] FRAMING [ INAL
[ ] FIREPLA S CHIMNEY
REMARKS:
J
DATE �� w INSPECT
�f�1
M-1802
BUILDING DEPT.
NSPECTION
[ VIF NDATION 1ST [ ] ROUGH PLBG.
NDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE j CHIMNEY
REMARKS:
DATE Z NSPECTO
FIELD INSPECTION REPORT D&R COMMENTS
FOUNDATION (IST)
3
-------------------------------------
y
x
r C
FOUNDATION(2ND) ( 7
z
) o
y
ROUGH FRAMING& t
PLUMBING
c
S
C
INSULATION PER N.Y. S y
STATE ENERGY CODE
LOW
C�7
FINAL
ADDITIONAL OMMENTS S
O
z
m
m
f�
b
W o
z
I x
a
y
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TOWN OF SOMOLD KIWINU PERWE APMLICATION CHECKLI`
BUILDING DEPARTMENT Do you have or need rhe following,before appl)nr
TOWN'HALL Board ofHeakh
SOUTHOLD,NY 11971 3 sets ofBw7ding Plans
TEL: 765-1802 , survey
PERMIT NO. otB(5-12, Check
Septic Form
N.Y.S.D.E.C.
Trustees
Examined 3 20 Z Contact:.
Approved 6 20 z— Mail to:
Disapproved a/c
Phone:
r
�J1f r Building r
t, �' IY7
APPUCA.TION FOR BUII.DING PERMIT
Date 120
INSTRUCTIONS
a
a. This application MLT a 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.
e.No building shall be occupied or used in whole or in part for any purpose what-so-ever until a Certificate of Occupan
is issued by the Buildiag hispector.
APPLICATION IS HEREBY MADE to the Building DeparGnent for the issuance of a Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold, SuMlk County,New York, and other applicabkLaws, 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,ordinanoes,building code,housing code,and regulations, and to admit
authorized inspectors,on preeraisses and in building for necessary'inspections.
(3ismare of Cwhom or name,if a corporation)
X650 (tfG1�2v,�w .Ik 50A-W4)
(Marlmg address of applicant)
State whether applicant is owner,lessee,agent, architect, engineer, general contaactor, electrician,plumber or.builder
Name of owner of premises /14a& ILL
on the.tax roll or 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 proposed work will be done: �
10 5[7 ti,)Aiz- U �J `)o LM4nL1)
House Number street Hamlet
County Tax Map No. 1000 Section c 7R Block 7 Lot a 7
Subdivision Filed Map No. Lot -
(Name)
2. State existing use and.ocaupaaey of preltnses and iitwded use and occt4me3r of proposed cowtruction:
a. Existing use and oocdp4acy QErI<
b. Intended use and occupancy
3. Nature of work.(check which applicable):New.Building' Addition Alteration
Repair Removal Demolition Other Wolk 13 u/e 0 Dcc NC
(Description)
4. Estimated Cost /o�C�OI — 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
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. Depth
Height Number of Stories
Dimensions of same structure with alterations or additions: FrontC- Rear
Depth Height Number of Stories
8. Dimensions of entire new construction:Front Rear Depth
Height Number of Stories
9. Size of lot: Front I O 0 Rear t n O ' Depth
10. Date of Purchase Q 7 4eoo Name of Former Owner hAtUl <WCE 9s<�J
11. Zone or use district in-which premises are situated /
12. Does proposed constructions violate any zoning law, ordinance or regulation:
13. Will lot be re-graded A O Will excess fill be removed.from premises: YES NO
14. Names of Owner ofpremises Mince SCFNL(-- Address f_esa bvhr)-1x:Vy-, 'WPhone No.Zl$--2�g3
Name of Architect Address Phone No
Name of Contractor Address Phone No:
15. Is this property within 100 feet of a tidal wetland? *YES NO
• IF YES, SOUTHOLD TOWN TRUSTEES PERMITS MAYBE 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 � C
big duly s'om,deposes,and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)He is the e Z'y T
(Contractor,Agent, Corporate Officer,etc.)
of said owner or owners,and is duly authorized to omt or have
1true performed the said work and to make and file this application
that all statements contained is this application are true to the best of his knowledge and belief, and that the work w ll be
Performed in the manner set forth in the application filed therewith.
Swo 'Toflore me '
of
0 77
otarryy PublicLYNAM. 90HN �.._ of Applicant
NOTARY PUBLIC,State of New York
No.01806020932
Oualified'in Suffolk Coun
Term Expires March 8,20txj
i
BUILDING PERMIT EXAMINER CHECK LIST
DATE ISSUED: —/—/02
DATE REVIEWED: 5/�/02
APPLICANT: �c"'L`' DAT9 SUBMITTED: 3 /d /02
SCTM# DISTRICT: 1,000, SECTION: BLOCK: �, LOT:
STREET ADDRESS: CITY: C �Ov> SUBDIVISION:
PROJECT
ESTIMATED PROJECT COST: ARCHITECT/ENGINEER: /SIA FAST TRACK? Nd
SINGLE & SEPARATE CERTIFICATION-REQUIRED? XO NOTES: --
LOTS 40,000SF-100-24.Lot recognition,(CREATED before June 30,1983),UNDERSIZED LOTS FROM JAN.1997 100-25.Merger.(A nonconforming at any time after 7/1/83)
ZONING DISTRICT: 12-yo CONFORMING? k(c,
v
REQ. LOT SIZE: \to-000 ACT. LOT SIZE: 'y sus REQ. LOT COV. Z0 ACT. LOT COV.
REQ. FRONT SS PROP. FRONT -/y,-7`REQ SIDE 0&< ACT. SIDE
REQ. REAR 3; PROP. REAR So
WATER FRONT? ^' ° DESCRIPTION: —
PANEL #: !�G FLOOD ZONE.;4 ,
APPROVALS REQUIRED
SUFFOLK COUNTY HEALTH D PT: YES o0(BED#): DTE:_/_/_ PERMIT#:R10-
TOWN SEPTIC RECEIPT: Y o
NEW YORK STATE DEC: P" c 9/1/75 YES or
SOUTHOLD TOWN TRUSTEES: YES o
TOWN ZONING BOARD APPROVAL: YES o
TOWN PLAN. BOARD APPROVAL: YES o
TOWN HISTORICAL PRE (SPLIA): YES o O
NYS ENERGY: YES OR
EGRESS (18 H min.? 4 sq total) ,..._ VENT (SQ. FT. x 4%) LIGHT(SQ. FT. x 8b/o) --
BUILDING PERMITS OPEN/EXPIRED: BPIf J(5- -Z/C/0 Z-80�9 N fD
HAVE PRE CO'S : Y OR N BP/? -Z/C/0 Z- /2-?0 S!t�- 66 b
NOTES:
FEE STRUCTURE: FOUNDATION: SF
FIRST FLOOR: SF
SECOND FLOOR: SF
OTHER: SF INIT OTHER TOTAL
TOTAL: SF FEE FEES
1. ( —SF)- ( SF)= SF X $ � =$ +$ �v +$ /" _ �-)4
F'c ooa pene/Yt
2. ( SF)- ( SF)= SFX$ =$ +$ +$ = $
Town Hall Annex ~O l0 Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O. Box 1 179
Southold,New York 11971-0959
COUNV
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
September 24,2008
Mr.M.Schill
1050 Waterview Dr.
Southold N.Y. 11971
To Whom It May Concern:
It has come to the attention of the Southold Town Building Department that a Certificate
Of Occupancy has never been issued for Building Permit # 28151 issued on March
8,2002. In order to rectify this situation please submit the following to this office.
If you have any questions feel free to contact this office at 631-765-1802 between the
hours of 8AM-4PM.
An application for Certificate of Occupancy is not on file. (Enclosed)
No Electrical Certificate on file.
The Check is not on file -$25.00 a 2 /71 Gv C D/tet �G
No Health Department Approval on file.
No final inspection has been made.
No Plumber Solder Certificate on file. (All permits involving plumbing being
issued after April 1, 1984)
Certificate of Compliance from Southold Town Trustees.
Approval of the Zoning Board of Appeals*
Final Planning Board Approval.
f S j/"
Town Hall,53095 Main Road Fax(631)765-9502
P.O. Box 1 179 x,G� Telephone(631)765-1802
Southold,New York 11971-0959
l roUNTY,
7jr>l�c,
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
September 25th, 2006
Mark Schill
1050 Waterview Drive
Southold N.Y. 11971
TO WHOM IT MAY CONCERN:
We re unable to complete your Certificate of Occupancy because of the following reasons:
Anapplication for Certificate of Occupancy is not one file. (Enclosed)
No Electrical Underwriters Certificate on file.
The check is (not on file) $25.00 Returned outdated
No Health Department approval on file.
No final inspection has been completed.
No Plumber Solder Certificate on file. (All permits involving plumbing issued after
4/1/84)
Final Town Trustee Approval
BUILDING PERMIT:#28151-Z
Thank you for your cooperation.
SOUTHOLD TOWN BUILDING DEPT.
Please note if permit is expired,a renewal fee may be required.
O�Og�FFO�,�cOG
o� y�
W =
Town Hall,53095 Main Road Q Fax(631)765-9502
P.O. Box 1179 yif'O a0� Telephone(631)765-1802
Southold,New York 11971-0959 1 �►
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
November 19, 2002
Mark Schill
1050 Waterview Dr
Southold, NY 11971
RE: 1050 Waterview Dr
TO WHOM THIS MAY CONCERN:
We are unable to complete your Certificate of Occupancy because of the following reasons:
X An Application for Certificate of Occupancy is
not on file. (Enclosed)
No Underwriters Certificate on file.
X The check is (not in file)$25.00
No Health Department Approval on file
No final inspection has been completed.
No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT#28151-Z
Please contact our office on this matter. Thank you for your cooperation.
SOUTHOLD TOWN BUILDING DEPT.
AIS
PLICATION s---
. • P'/�GE I of a
2i J2
TOWN OF 5 !HOLD
FLOODPLAIN DEVELOPMENT Pf-RMIT'A.I PL1t IC ON
This form is to be filled out in duplicate.
SECTION 1 GENERAL PROVISIONS (APPLICANT to read and sicnl:
1. No work may start until a permit is issued.
2. The permit may be revoked if any fake statements are made herein.
3. If revoked, all work must cease until permit is re-issued.
4. Development shall not be used or occupied until a Certificate of Compliance is issued.
5. The permit will expire if no work is commenced within six months of issuance.
6. Applicant is hereby informed that other permits may be required to fulfill local, state and federal regulatory
requirements.
7. Applicant hereby gives consent to the Local Administrator or his/her representative to make reasonable
inspections required to verify compliance.
8. I, THE APPLICANT, CERTIFY THAT ALL STATEMENTS HEREIN AND IN ATTACHMENTS TO
THIS APPLICATION ARE, TO THE BEST OF MY KNOWLEDGE, TRUE AND ACCU T
o�L --
(APPLICANTS Sft; IATURE)
DATE
SECTION 2 PROPOSED DEN-LOPMENT (To be completed by APPLICANTI
NAME ADDRESS TELEPHONE
APPLICANT ^^ /1 y �G i L
BUILDER
ENGINEER
.PROJECT LOCATION:
• To avoid delay in processing the application, please provide enou6 information to easily identify the project
location. Provide the street address, lot number or legal description (attach) and, outside urban areas, the
distance to the nearest intersecting road or well-known Landmark. A sketch attached to this application showing
the project location would be helpful.
Su�fS�� rY q
FDP(93)
' r
APPLICATION
PAGE ? OFa
DESCRIPTION OF WORK (Check all apphcablc boxes)
A- STRUCTURAL DEVELOPMENT
AC'TiVITY STRUCTURE TYPE
❑ New Structure ❑ Residential (1-4 Family)
*,Addition ❑ Residential (More than 4 Family)
❑ Alteration ❑ Non-residential (Floodproofmg? ❑ Yes)
❑ Relocation ❑ Combined Usc (Residential & Commercial)
❑ Demolition F ❑ Manufactured (Mobile) Home (In Manu-
0 Replacement factured Home Park? ❑ Yes)
ESTIMATED COST OF PROJECT S
B. OTHER DEVELOPMENT ACTIVITIES:
❑ Fill ❑ Mining ❑ Drilling ❑ Grading
❑ Excavation (Except for Structural Development Checked Above)
❑ Watercourse Alteration (Including Dredging and Channel Modifications)
❑ Drainage improvements (Including Culvert Work)
❑ Road, Street or 6Tdge Construction
❑ Subdivision (New or Expansion)
❑ Individual Water or SeWr System
❑ Other (Please SpectTy)"
After completing SECTION 2, APPLICANT should submit form to Local AdrnI iscrator for review.
EMON 3 FLOODPLAIN DETERMINATION (To be completed by LOCAL ADMINISTRATOR)
The proposed development is located on FIRM Panel No. Dated
The Proposed Development:
❑ Is hM located in a Special Flood Hazard Area (Notify the applicant that the application
review is complete and NO FLOODPLAIN DEVELOPMENT PERMIT IS REQUIRED).
FL
• ❑ Is located in a Special Flood Hazard Arm.
FIRM zone designation is
ioo-Year flood elevation at the site ts: Ft. NGVD (MSL)
❑ Unavailable
❑ The proposed development is located in a floodway.
FBFM Panel No. Dated
Cl See Section 4 for additional instructions.
SIGNED DATE
APPLICATION
PAGE 3 OF a
SECTION 4 ADDITIONAL INFORMATION REQUIRED {To he coin nlctcd by LOCAL ADMINISTRATOR)
The applicant must submit the documents checked below before the application can be processed:
O A site plan shoving the location of all existing structures, water bodies, adjacent roads, lot
dimensions and proposed development.
❑ Development plans, drawn to scale, and specifications, including where applicable:details for
anchoring structures, proposed elevation of lowest floor (including basement), types of water
resistant materials used below the fust floor, details of floodproofmg of utilities located below
the first floor and details of enclosures below the fust floor.
Also
❑ Subdivision or other development plans (If the subdivision or other development exceeds 50
lots or 5 acres, whichever is the lesser, the applicant must provide 100-year flood elevations
if they arc not otherwise available).
0 Plans showing the extent of watercourse relocation and/or landform alterations.
❑ Top of new fill elevation Ft. NGVD (MSL).
❑ Floodproofmg protection level (non-residential only) Ft. NGVD (MSL). For
flolkStoofed structures, applicant must attach certification from registered engineer or
architect.
0 Certificatio from a registered engineer that the proposed activity in a regulatory floodway
will not result in any increase in the height of the 100-year flood. A copy of all data and
calculations supporting !his finding must also be submitted-
0 Other:
SECTION 5 PERMIT DETERMINATION (To be completed by LOCAL ADMINISTRATOR
I have determined that the proposed activity. A. O Is
B. 0 Is not
in conformance with provisions of Local Law tR_. 19_ The permit is issued subject to the conditions
attached to and made part of this permit.
SIGNED DATE
If BOX A is checked, the Local Administrator may issue a Development Permit upon payment of designated
fee.
If BOX B is checked, the Local Administrator will provide a written summary of deficiencies. Applicant may
revise and resubmit an application to the Local Administrator or may request a hearing from the Board of
Appeals.
APPLICATION a
PAGE a OF a
APPEALS. Appealed to Board of Appeals? O Yes O No
Hearing dale:
Appeals Board Decision --- Approved? O Yes ❑ No
Conditions
SECTION G &$ BUILT ELEVATIONS (To be submitted by APPLICANT before Certificate of Compliance
is issued
The following information must be provided for project structures. This section must be completed by a
registered professional engineer or a licensed land surveyor (or attach a mrtification to this application).
Complete 1 or 2 below.
1. Actual (As-Built) Elevation of the top of the lowest floor, including basement (in Coastal Hieh Hazard
Areas, bottom of lowest structural member of the lowest floor, excluding piling and columns) is:
FI'. NGVD (MSL).
2. Actual (As-Built) Elevation of floodproofmg protection is FT. NGVD (MSL).
NOTE: Any work performed prior to submittal of the above information is at the risk of the Applicant.
SECTION 7 COMPLIANCE ACTION (To be completed by LOCAL ADMINISTRATOR)
The LOCAL ADMINISTRATOR will complete this section as applicable based on inspection of(be project to
ensure compliance with the community's local law for flood damage prevention.
INSPECTIONS: DATE BY DEFICIENCIES? ❑ YES ❑ NO
DATE BY DEFICIENCIES? ❑ YES ❑ NO
DATE BY DEFICIENCIES? ❑ YES ❑ NO
SECTION 8 CERTIFICATE OF COMPLIANCE(To be comnleted by LOCAL ADMINISTRATOR)
Certificate of Compliance issued: DATE--- BY:
Attachment B
SAMPLE
CERTIFICATE OF COMPLIANCE
for Development in a Special Flood Hazard Area
TOWN OF SOUTHOLD
CERTIFICATE OF COMPLIANCE
FOR DEVELOPMENT IN A SPECIAL FLOOD HAZARD AREA
(OWNER MUST RETAIN THIS CERTIFICATE)
PREMISES LOCATED AT: PERMIT NO.
PERMIT DATE
OWNERS NAME AND ADDRESS: CHECK ONE:
❑ NEW BUILDING
❑ EXISTING BUILDING
❑ VACANT LAND
THE LOCAL ADMINISTRATOR IS TO COMPLETE A. OR B. BELOW:
A. COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF
LOCAL LAW #_, 19
SIGNED: DATED:
B. COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF
LOCAL LAW # , 19_, AS MODIFIED BY VARIANCE #
DATED
SIGNED: DATED:
C/C(93)
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• { The sewage disposal and water supplq
PCLHAsewage MANOv,N.Y. 10803 facilities for this location have been
(Tel. 9/4-738-9'796) inspected by this department and found
Cl wR1RAE /�r8$3 5q.{f to be sat�s�to a ..►/
N. Chief of General Eng neerinQ
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D'
" � I. FOR APPROVAL OF CONSTRUCTION ONLY
C/Qpr - THE WATER SUPPLY AND SEWAGE
-'d'•f�
DATE: DISPOSAL SYSTEMS FOR THIS RES)
DENCE WILL CONFORM TO THE
H. S. REF NO I+ - / /_/ f STANDARDS OF SUFFOLK CO. DEPT
CCI OF HEALTH. SERVICES.
APPROVED: !
1
17' h r APPLICANT
1
1
TOWN OF SOUTHOLD PROPERTY RECORD CARD �-
OWNER STREET VILLAGE DIST. SUB. LOT
9aik i I 1qm 4odlllul Jtew �R. m� Ps
FORMER OWNER /� � / N E aR ACR.
-0wrek7 . f7T]�.FO✓S6 A%R / cJ .b S'. WI 0( ✓Sa f . 333
S W TYPE OF BUILDING
.✓ Gu . IJo L W r(lC
RES. 02�U SEAS. VL. FARM COMM. CB. MICS. Mkt. Value
LAND IMP. TOTAL DATE REMARKS
/ 8 7 /
S— Ifo _ J"lJ. l/c c f, -T, - Z.A./464�,r,.^a i✓K r.r ,L
.F'/!f! # f/S 4 �pla �f n�/ EC. a 0.
Sfa
VF,�,,�''V;
a hood -L /ZD�ozS q�✓sd� �sfil/� a�U 183oc
Tillable FRONTAGE ON WATER
Woodland FRONTAGE ON ROAD eo -
Meadowland DEPTH
House Plot BULKHEAD
Total
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