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HomeMy WebLinkAbout1276DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25.70 -1-49 BOX 12 I ME 16 I IN, Iwo in a oil ti NO I xf - I I -or km! T J k1n.N3 L Z 1 1 01276 APPLICATIGN - ADDITION - (RESIDENTIAL ONLY) :It Name: L,)v t,�- Phone /!%LTG61 % r Year of Original Street ._id',%o�, JJ - :-,�'- ii,r � ...GrJC'.S rL.C•t1on�� Mailing Address Z-'�- Town PCHD Permit Description of A.dci ticn- NC'.ir�`�c �JD P Number of existing bedrecros_ Proposed number of bedrooms y A] Square Footage of existing house ( cl 2,-D B] Square Footage of Proposed Addition :3 % 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, EREWSTER, NY 10509, Phone 278 -6130 with the following information. IF THE PROPOSED ADDITION IS G=REATER THAN 15% CERTIFIED CHECK CR MONEY CRDER 1. CHECK for $100.00 2. Sketch of existing floor plans (all living area including basement, if any) Non- professicnal drawing 3. $me -. i prccosed floor plan. Ncn professional drawing 4. Copy of survey showing well and septic location, to the best cf your kncwledee. Include date of installation if known. Any questions please contact William Hedges or Robert Morris. IF THE A.DD T ICN '?JILL 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 proµ:sed 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 App roved Date: - -1 cc: BI (T) addition TITLE,%" �c t ;' - _ _ � _ _ I i APPLICATION - ADDITION - (RESIDENTIAL ONLY)' Name: Va ' �� - �3 ;5 Phonegi Y2_ 617Y Year of Original -�, . � -- -.._ _._.......:.. -- •- Constr- uct..or;.��!7�._ Mailing Address e- Town_ PCHD Permit Description of Addition N&k c.�Sa� ' 02 -�_i� Number of existing bedrooms Proposed number of bedroctrs A] Square Footage of existing house B] Square Footage of Proposed Addition 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, BRENSTER, NY 10509, Prone 278 -6130 with the following information. IF THE PROPOSED ADDITION IS GREATER THAN 1501/0 CERTIFIED CHECK CR MONEY CRDER 1. CHECK for $100.00 2. Sketch of existing floor plans (all living area including basement, if any) Non- professicnal drawing 3. Sketch of proposed floor plan. Non professicnal drawing 4. Copy of survey showing we'll 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 ADDITICN WILL RESULT IN AN ADDITIONAL BEDRC0N1 THAN CERTIFIED CHECK CR MONEY ORDER 1. CHECK for $100.00 2. Sketch of existing floor plans (all living area including basement, if any) Non - professional drawing Sketch -of -proposed -floor .plan... Non professional drawing 4. Plans for the Sewage Disposal System prepared by a Professional Engineer meeting present code requirements, may be required. OFFICE USE Comments and /or conditions Approved -2� TITLE Date: -Z cc: BI (T) / addition 1, 1 ®Z ! r -- -- -- ! r - ' I • I _IX _ I _ r I r , -I I t ' I , r , LJ i .. _... .. �- .....�.— -.:— I ..I,._- .- .<,. -1 - ..'.."'^'�Y' ^'�:1F: � i�-�,.., I- ,.:' -a� I ""'° _ _ 1.,n- t�.,.�1 -. ///...-.. i�•''"4 :F .c: n�. •. t r A' fit- - ... -- - `. -- ell �-- ry 4r C7, ----------- .. .. 1Y -- I I I i ; v i i I j t I ' I j 1 i J J -; { i 1 i I I j � ' i I . .......... . ' 1 I ..�� -._- i __T-- 1. -_�_ -j -�. --I} L__._ , ' � I I � i 1 I ' j - ' � - i _ - I __- -_ _- _ -' __ I .._ _ 17 ----------- alL IA-_Il �-0 DEPARTMENT OF HEALTH Division of Environmental Health Services n TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 .._ __ .. _ .._ _ ... _..__ ... - APPLICATIOTQ TO CONSTRUCT A WATER WEL "L' PCHD PERMIT #� WELL LOCATION Street Address 30 ;Victory Road Town/Village/City Tax Grid Number Patterson, New York (Putnam Lake) WELL OWNER Name Donald Stirbis Address private 30 Victory Road, Patterson, O Public NY USE OF WELL © - primary 2 - secondary X$ RESIDENTIAL ❑ PUBLIC SUPPLY 0 AIR /COND /HEAT PUMP ❑ ABANDONED ❑ BUSINESS O FARM 0 TEST /OBSERVATION 0 OTHER (specify ❑ INDUSTRIAL O INSTITUTIONAL 0 STAND -BY ❑ AMOUNT OF USE YIELD SOUGHT 5 gpm /# PEOPLE SERVED 3 to /EST. OF DAILY USAGE gal REASON FOR DRILLING ❑NEW SUPPLY REPLACE EXISTING ❑PROVIDE ADDITIONAL SUPPLY ❑TEST /OBSERVATION SUPPLY 0 DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING i4:2 "� WELL TYPE RILLED DRIVEN E]DUG GRAVEL 13 OTHER IS WELL SITE SUBJECT TO FLOODING? YES $$ NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: n/;; Lot No. WATER WELL CONTRACTOR: Name MILL DRILLING, INC. Address: Putnam Avenue rP R P r IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: no. YES NO NAME OF PUBLIC WATER SUPPLY: n/a TOWN /VIL /CITY DISTANCE' TO PROPERTY FROM NEAREST WATER MAIN: n /a... LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED J ON REAR OF THIS APPLICATION ON P RA T 10/17/88 t �- (date) ignat re)` Robert M. Mill, President - PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: 1. Pump'the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. Date of Issue: 19� Date of Expiration: 196,7 Permit Issuing • fic' Permit is Non - Transferrable o I • -7. ---- OS- 7-4 -6o ja /7o d fcTo'�y I tl � IFOP At. a Vove- R e )r,4 tooy ; -'Y (O,v W A'A A APLV7,*",Aeo,* of 14-0,