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HomeMy WebLinkAbout2000DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 36.33 -1 -2 BOX 18 i %. ; rr oil v r , Lm L mg lot 02000 �b PHONE 9 / 4/ °7th' jY0 SITE LOMTION TQ 5: L, a • Zri MAILING ADMUss ' i Ae, Sr e S `tee' 6) •1/� PERSON INTERVIBM PCHD Canplaint # Name & Relationship (i.e, owner,tenant, etc.) DATE TYPE FACILITY (include sketch locating all adjacent wells): NOTE: Repair must be in same location and of same type as original sewage disposal system. Different location may require submittal of proposal from licensed professional engineer or registered architect. • _ 6._ . , , ®. , .+ 0). .6% Proposal approved rte= Proposal Disapproved roposal approved with the following conditions: 1. Procurement of any Town permit, if applicable. 2. Submission of as built repair sketch in duplicate showing: a. Owner's name. b. Site Street Name, Town and Tax Map number. c. Location of installed components tied to two fixed points (e.g.,house corners). d. System description (e.g., 1250 gal. concrete septic tank, three precast 6' diam. x 6' deep drywells surrounded by one foot + gravel). e. Installer's name and number. 3. System repair to be performed in accordance with the above proposal and conditions. I, as owner, or reported agent of owner agree to the above conditions. SIGNATURE rrweF ? Uhite (PM): YeUow Mm HE); Pink QRJli®nt) TITLE DATE . lik 2 4 x r �• ��• _l y�i •.7 F Proposal approved rte= Proposal Disapproved roposal approved with the following conditions: 1. Procurement of any Town permit, if applicable. 2. Submission of as built repair sketch in duplicate showing: a. Owner's name. b. Site Street Name, Town and Tax Map number. c. Location of installed components tied to two fixed points (e.g.,house corners). d. System description (e.g., 1250 gal. concrete septic tank, three precast 6' diam. x 6' deep drywells surrounded by one foot + gravel). e. Installer's name and number. 3. System repair to be performed in accordance with the above proposal and conditions. I, as owner, or reported agent of owner agree to the above conditions. SIGNATURE rrweF ? Uhite (PM): YeUow Mm HE); Pink QRJli®nt) TITLE DATE • - 1 15 �, 14� — ROAD -- E , 67 0 -7 l i / • �G i to + .� � \ � ,� r' '' , ; • 111 • rr .. t i4 • r_ .'. - . Vim" SPMAL OISTRCT 114 C OMATION LEGENO 1.. 'M101'(MTT U1IC owr�, lOT UM[ --'-' ID0 ) w{MCM 01 MDIDA IfM /Y1 —•- fg10 d N►t rOID M/O IMT= UML oewTT Ur! *"AJC tw AOGa YMT ^ ����. K.°0. 0.$T--T :MC X001 —�; I" bITMCT Lr1C —r.— rf C• 1p% 1 , L.0 —M— :q"I MMGT LM! �l� MSMCI VK �-r —� t.C. TI S— L •IDLMT bll MC1 14C �r —� aaC 4U1m1 wG4 MU�M'>I1 KCo I.W. .,O Om OECD \01 w.YI O<m Orlf rt•0. fJlr!< /1[0 •14 C.La (` TL L: 0 W i T I 1 .. •I 1_f 11 .f 0, l +04 I ,Y r,' , p-•N'C F.Cor. f 1, r1/M4010 I .9S � ' •' - %4.58 •'�.:. I � is =' �:;•� �; � ; I <. �� .;;�.��, . . . '. ; • rick ; B fi�nre �� � spit /eve/ dwelling LIZ ;4 ti , ,van oe i»v �t lbcn O 89, :..... .. _ p Ole -SHORE DRIVE (SO' wide 1 1 S(.i��VEY OF T'RLF'E ?FY PREPARED FOR v EORGE N08/LE ' BE /N[; 1519 - 1525 INCL. SHOWN ON SECOi /,`? MAP OF' P .1?,1v11,4V sirua rt * /A.' 1 7 JWN. OF P11 T :' _RJA/ PU TNA COUNT NEW YORK" SCALE tilt =.30' Soid mop :-i!ed Morch 20,/93/os M:7p N °/49 -A I J>>mes C. EdOe1� /!! SUrV2VQ/ who h)' rinnirp Fr -horol 4.7vrnnc R 1,-) ,7n