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HomeMy WebLinkAbout2875DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 62.13 -1 -60 BOX 24 �15� Is:. r ul"K.Muhimftm Ir �T W1.4 16 �1 �- L AL 02875 Pro (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. Proposal s Sianature & Title Proposal Disapproved If P//1- Proposal approved with the following conditions: Date 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 ccmponents 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 drywalls 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 agen, of owner agr to the above conditions. SIGMA ✓ TITLE 0WArP/)c0_ DATE PISS: White (P M); YeUc w (fin HE); ) PUTNAM OOUNTY HEALTH DEPAR24M DIVISION OF ENVIRONMENTAL HEALTH SERVICES Y PROPOSAL F'UR `SE(KAGF; DISP09AL SYST& REPAIR r OWNER'S NAME AAA, H u1-TAV i VtM LML WM HVCrAR -1 PHONE q1q -5 Zii ° 19,7?2 SITE LOCATION 44 M t v c. P U N W Vftc tom' O i 710 MAILING ADDRESS 5 7 btw-o j PiL , PtlNMA i1Aur�- -(� �3 ;'{ i.0S79 PERSON INTERVIEWED PCHD Camplaint # N%s Name & Relationship (i.e, owner,tenant, etc.) DATE i �t� ?j _ TYPE FACILITY �,ti6LL- t'Am, ges, PROPOSED I;BTALLER CLO56 �"4_) (�� c# WA TV" - PHONE Pro (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. Proposal s Sianature & Title Proposal Disapproved If P//1- Proposal approved with the following conditions: Date 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 ccmponents 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 drywalls 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 agen, of owner agr to the above conditions. SIGMA ✓ TITLE 0WArP/)c0_ DATE PISS: White (P M); YeUc w (fin HE); ) JOHN D. LaSPALUT'O o ARCHITECT 3613 S. Procyon LAS VEGAS, NEVADA 89103 (702) 365.1510 TO &WigAl 61;51?77C j ? -7'W. 2vt fir: LEETTEER OF UMRZEFTUR, DATE i� 9� JOB NO. A�TEIJ Tj vkt. ., .. ..• .. .. . LTI > WE ARE SENDING YOU P('Attached ❑ Under separate cover via the following items: • Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications • Copy of letter ❑ Change order ❑ COPIES DATE NO. DESCRIPTION t • For your use ran �:b 5eLji46,E O(Sro s,tc, 4ePM 2 Approved as noted ❑ Submit copies for distribution > ❑ P ❑ Returned for corrections ❑ Return corrected prints For review and comment ❑ V❑ FOR BIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US I.HP-SE ARF ..TRAruSM1T! EI)..as. cher_ksc+- 7101 , Y: - - — _.O .. • For approval ❑ Approved as submitted ❑ Resubmit copies for approval • For your use ❑ Approved as noted ❑ Submit copies for distribution > ❑ As requested ❑ Returned for corrections ❑ Return corrected prints For review and comment ❑ V❑ FOR BIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS Ptao5e ge l y" CyA(iu 01yj� Cf1- Wi0 (2'0y&-e— r Ocy Nt7c HC Z cVLZ'H ru e;'7 Li Nc o LI6 COPY TO /(yts SIGNED: PRDDUCT20.3 es ine, GM M= 01471. If enclosures are not as noted, kindly notify us at once. _ _. �. •� ^z� s:`,i.- of �,�. `� .. i u N I CLIP N u All JIGI i 1 W I b- � r 0 ir- PZ I