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01132
` I APP__,Cf AATICid - ADDITION (RESIDENTIAL CNL:I ) I
r Name:-DO ZG S �T� �� Phcne? � yV010 Year of Original
Street s~�� %h �r. TM# ��P i -% G,nstrucicn _._._..
Mai 1 ing' Acdress/ -v % 4'_SO4 b+-� Town PC D = errni'
Descrioticn of Additicn �f' /� �'�� ®f"0
Number cf existing bedrooms ?rcDcsed number cf �ecr,cros
A] Square Footage of existing house 7�
BI Square Footage of Proposea Additicn_ '7G SP o
% increase in floor area ( A divided by 3) X 1 G
Please submit this form and the following to PUTNA.M CCIJNT( HEALTH DEPARTMENT, 4
GENEVA FCAD, EREWSTER, NY 10509, Phone 278 -513C with the fcilcwing information.
IF T HE PRCPOSED ADDITION IS GREATER THAN 15%
CERTIFIED CHECK CR MONEY CRCER
1. CHECK for $100.00
2. Sketch of existing floor plans (a;l living area including basement, if any)
Non - professional drawing
3. Sketch of proposed floor plan.
Non professional drawing
4. Copy of survey shcwing well and sectic lecaticn, tc the bes- cf your
knowledge. Include date cf installation if known. Any auesticns please
contact William Hedges or Rcbert Morr;s.
IF THE ADDITION WILL RESULT IN AN ADDITICNAL BEDRCCM THAN
CERTIC TED CHECK OR, MONEY CRC)ER
1. CHECK for $100.00
2. of existing floor P, lans (all livirg area including basement, if any)
Non- professional drawing
3. Sketch of proposed floor plan.
Non professional drawing
4. Plars for the Sewage Disposal System prepared by a Professional Engineer
meeting present code requirements, may be required.
OFFICE USE � — / -G-�,
Commer• ; _ r:j /cr conditions
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Approved by:A0'1° -' TITLE 11-5 11-
Date: oopeo .2 / ��/
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A.FPLICATICN - ADD.ITICN - RESIDENTIALCNL
Name: Au 9IA5 /,e,_4cly Phone yui'27Y`��� 9 Year of Original
Street �5...�, L�,,`( 37: ��� TIM: 24 c7 Constructi_cn
Mailing Address) _e f5 o,v A;,/ / 256 Tcw ,� PT6cx PCHD Perm i t
.Description of Addi t icn6G /m//c- wr1A�'6 a j?DiziVf
IVA .. i ✓d r /,--
Number of existing bedrooms, Prop, sed number of bedreofns
A] Square Footage of existing house 3�l �la�i 76,5 SF
B] Square Footage of Proposed Addi tion S Art, e^ - 76�!'S
% increase in floor area (.A divided by B) X 100 =
Please submit this form and the following to PUTW4 CCUN7Y HEALTH DEPARTI4ENT, 4
GENEVA ROAD, EREWSTER, NY 10509, Phone 278 -6130 with the following information.
IF THE FROFOSED ADDITION IS GREATER THAN 15%
CERTIFIED CHECK OR MONEY CRDER
1. CHECK for $100.00
2. Sketch of existing floor plans (all living area including basement, if any)
Non- professional drawing
3. Srketch of proposed floor plan.
Non professional drawing
4. Copy of survey showing well and septic location, to the best of your
knowledge. Include date of installation if known. Any questions please
contact William Hedges or Robert Morris.
IF THE ADDITION WILL RESULT IN All ADDITIONAL BEDROOM THAN
CERTIFIED CHECK_Cf? MONEY OFD R
1 CHECK for $100:06::�11-
2. -tch of' existing floor plans (all living area including basemment, if any)
Non- professional drawing
3. Sketch of proposed floor plan.
Non professional drawing
4. Plans for the Sewage Disposal System prepared by a Professional Engineer
meeting present code requirements, may be required.
C E -4 OFFI 7�� 3
Comments and /or conditions
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GO Aporo ed by:
a2 C
Date :j 0
cc: BI (T)
addition
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Name L /0 U
APPLICATION - ADDITION - (RESIDENTIAL, ONLY)
Phnney /y- Z 7
c( Year of Original
Street 44 4,v TM# Construction 145 �
Mailing Address cis ?,'41Ard\ 1)r.'V TownTefte IWI PCHD Permit
N u95441rs Ne,w 400"41'
Description of AdditionTe(kooc, Z $eA?- ..:^+S oA rs -}o
pi ckatJ MhKe. '9-g5,-- Irv, j oFF;Ge•
.Number of existing bedrooms Proposed number of bedrooms 7—
A] Square Footage of existing house W1• S f
B] Square Footage of Proposed Addition 716 r SF
% increase in floor area (:A divided by B) X 100 =
Please submit this form and the following to PUTNAM COUNTY HEALTH DEPARTMENT, 4
GENEVA ROAD, BREWSTER, NY 10509, Phone 278 -6130 with the following information.
IF THE PROPOSED ADDITION IS GREATER THAN 15%
CERTIFIED CHECK OR MONEY CRDER
1. CHECK for $100.00
2. Sketch of existing floor plans (all living area including basement, if any)
Non - professional drawing
3. Sketch of proposed floor plan.
. Non professional drawing
4. Copy of survey showing well and septic location, to the best of your
knowledge. Include date of installation if known. Any questions please
contact William Hedges or Robert Morris.
IF THE ADDITION WILL RESULT IN AN ADDITIONAL BEDROOM THAN
CERTIFIED CHECK OR MONEY ORDER
1. CHECK for $100.00
2. Sketch of existing floor plans (all living area including basement, if any)
Non- professional, drawing,
3. Sketch of proposed floor plan.
Non professional drawing
4. Plans for the Sewage Disposal System prepared by a Professional Engineer
meeting present code requirements, may be required.
OFFICE USE
Comments and /or conditions
Approved by: TITLE
Date:
cc: BI (T)
addition