Loading...
HomeMy WebLinkAbout2322DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 41.10 -2 -39 BOX 20 wr r m 16 ML l i 61 oil P, , 1--lo Wil 02322 FROM : NEWTON PHONE NO. : 18006477307 Mar. 29 2004 :54AM P2 PU-1 NAON4 COUNTY REAL-114 DEPAIZ 1'•I� =• ":' DfVN'10x,,' UP ENWRON...VENTAL I-M,2\11 TH S RV,r: FROUSAL EUR SEWAGE DISMAL.- 1A 0r-ICIA!, ONLY SITE LOCATIONI„� W1h7,. PII��NS'S ,S V;.An, NG 1tllDRESS_ �t2 PERSON LN-TTER14RVr - _S Cale �� .�� "w;; r.� C'ct�:t,l<u.z t n .. ) S_�trn -Name &I Relatiopship 1,o.. owner, tcnant, Ftc:,> DA-11'_._.1, PROrOSED NSTALLER A-m- ADDRESS IFL.E "sCi1.51`R,i'.1'IC) ";r.'. Proposal (include sketch locating; al•l.ad acenR wells),.-, must;l:in saiYic locatian.arid of same type as original:cwac..disp41 �j stun .nifferent locatkii; 0# req irc subntittal.:of proposal frairi licansetl professional ongineer or repisxrad Lxr%himct. I, as owner, or eported agent of owner agree to the conditions stated on th1A four P! R G 1 tht, fo fl owir co adili4 1. Procuremcht..of any Town permit, if applicable. 2. Subnusaian'of as built repait sketch in duplicate showing; a, Owner's namo b. Site Street Name, Town and Tax Map number. C . Location of installed Components tied to two fixed points (e.g.,house t.c-trwts ). d. System description (e.g., 1250 gal, Concrete sepdc tank, three erect 5_ u' 01' iarn. X 6' c_up e Installers' name and number, 3. System repmr io be performed in =otdarice with the above propnsAl ar!ci Proposal approved� _ inspector's Signature &; Titic WPM- White (PCHD): Yellow (TAW-1. B11,: Pink (aflnlicantl MAR -29 -2004 MON 08:11 TEL:845- 278-7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 2 FROM NEWTON a 1 LU[�T1:a '�tOLF:v Ali Publle f1va/A Diree ror PHONE NO. : 18006477307 Mar. 26 2004 10:59AM P2 � , DEPARTMENT OF HEALTH 1 C1emeva Road, Brewster, New yolk Io5o9 EaviroiftmBbi Health (845)278-6130 Fay(180)278-7921 ?pursing Sonkes (845) 278 -6558 WIC (94S) 278 - 6678 Fu (845) 27 9 • 6085 Fsirly InterveniontPreschool (845) 278 - 6014 Fax (84$) 278 - 6&8 SEPTIC, SYSTIEM YN-STALLE+ R REGISTRATION FORM RQb1=RT Y. BONDI County Fx¢cutive Business �.6, owner A LtowaP• k . N CLOTIDr!4 Busine -m ElMdress Business Phono (�J•tf) �'l Yc77zn . Emergency P, gom&j ` o--57 W2 Fax Phone $coo tl ^ ©2 Tax I.D. T_T �3 4 R a Se,v �e�?r cvidc�! i' C, Lae.. FCC 64C� �._..:_�... _ _ - tore- Compensasozsititf+i�?Sivs "P�icyi�'�9tiY� Epiraixai Date ma—i —040 Corpmtioa of Inc, ( fIlidavit required) President _V.P:.. .j rrr3fiLX8T D1r�CtOf a — - —. • �......_ 7, as owner or agent, ag: ec to follow the regulatior19, procedures and policies of the Putr18?u County Heakh Dept for the in=llation and repair of subsut'�ce sewage treatment systctns. Signature. Title bate 3- e-jr-O Approved Cotrimexats� _ -- _ .epdc ingW1— o-:afpm I v610? MAR -26 -2004 FRI 10:16 TEL:845 -278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 2 FROM : NEWTON PFIONE NO. : 18006477307 Mar. 26 2004 10:59AM P3 Si..: � 'ti'.nilrl�Y�wV. 1 rte. .. �.. _ _ .. _ _ . •.. . - . _ .. ... ...-1 ... r .'f j G.�. rM `. THOMAS L CURRAN ;. ? RUTH AL MMER. SCAT E OF-,NEW YORK = ; �. �`� �_•• E"°` °''°° bEPARmamr OF STATE EDWARD D. HAnm : {{r DFPUty J oratieao 'z Charles Blank,Esq.., Albany, Appr I 19 48, 0/0. Blank & Gaumbin4,, -;; 1006 'Brown fit., :Her :Bldg. 337: 6S Peeklakills N.Y. Certiicste. of . ................................ .._...... .... . ...... ... j 3 Of .......... . .. has been filed todx y. - -_,_.� j EDWARD D. TIARPEk, Del,uty SKretary of.Stae ,•t ti Fees and tax paid as follows -. Received b Filing - ................ ... ...._ ............................... - .$ 40. t1G Certified p , Tax,a x'/20. of I% on; .............. ................ ... . ..::. - COAWS 09 of------ ---- -- - - -- shares pmr val , per are oa.------ - --22Q . h. "5C share .•._s are$ q►iihovt• °par value, $ �.Q. ©fl•�. . •,T.otal,� ;:�p�QQ. °:;, �� ~� County . We stohe stet = f' Refund $ Aegaartment. of $toe w porpl 106 IIrR4444iM (arrfi7) .......... ............................... - M o; p'��•ru • M.. ..., ... -,.. � •' •�'i.; _._ . .. • . .. ;' � i�.� . �:�. i � 4.'c'.'Y � =�Y `fi'NJ tt •Cti k r X' F�•-'(�• j MAR -26 -2004 FRI 10:16 TEL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 3 E FROM : NEWTON PHONE NO. : 18006477307 Mar. 26 2004 11:00AM P4 NC",'N YORK STAYM OF-PARYMENT OR TAX T. I:IN AND FINANCE SALES TAX fe Vrid A;l CERTIFICAT't Pf- 'AUTHORITY IVIENTIFICATION NUMBER (U$Z TNIS NUMBER ON ALL. RETURNS •�•�• AND CORREsPONDENCE) ;,•s. •x BUSINESS - - co�� NAME �';3:;74i�r�� BUSINESS' ADDRESS �, • ;,; ., ; ;, Oe -a 'y As outhmized to collect sales and use.toxmi under AsfICles ?$pond 29 of the New.Yolk Slate 7 ox taw. . 7RANSFERABLE ` this Gs►t•i(icdte Mirs /'be erominenel�r:d: r1 Iayed in your place of bV:ines. ? :. STv!OS (4,78) wry •� ��+J 41 MAR- PF, -P0A4 FRT 10 :17 TFL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 4