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02933
Locate
Owner
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services, Carmel, N. Y. 10512
AR_!h t ^-L' c !f GAL +• e,F' G �.�••- :�
LOS.. i1,�,o L:4 SYt'�:�_E..O "s.t'::...� :,�'.,���d3 � -G-. ��r... VA L Li>Z.�.
T� own or Village
Separate Sewerage System built by
Consisting of Gal. Septic Tank
Other requirements J f
Water Supply: -it Public Supply From
Private Supply Drilled By
Section Block ^► ^� c i�
Lot , Job
Address r n V� 1J A � v /1 ALLAZ �j ) °
lineal Feet X width trench
/y� Address t
Building Type .�QV_A =1 (C% •�A No, of Bedrooms �'- Date Permit Issued
Has Erosion Control Been Completed?
1 certify that the system(s), as listed serving the above premises were constructed essentially as shown on the plans of the completed work (copies of which are
attached), and in accordance with the standards, rules and regulations, plans filed, and the permit issued by the Putnam County Department of Health.
Date / Certified b
G i / 21 A
Address `' `��V Q License No,
Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary
conditions resulting from such usage. Approval of the separate sewerage system shall become null and void as soon as a public sanitary sewer becomes
available and the approval of the private water supply shall become null and void when a p ater supply becomes available. Such approvals are
subject to modification or change when, in the judgment of a Commissi er of H such revo on, modification or change is necessary,
r
Date 7 ^— By Title a
s.
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental.Health Services, Carmel, N. Y. 10512
k l! i ivA 14i IAt
Town or Village ^`
CONSTRUCTION PERMIT FOR SE4►�l GF- WSP05AL C1STcivl
Located at —
Subdivision _
Owner
Building Type
Lot Area to I tSE�V
Section /{ Block a �f
Lot `Y� Job ✓ LV
Address
Number of Bedrooms Total Habitable Space i
Separate Sewerage System to consist of LKtS1'�— Gal. Septic Tank lineal feet X
To be constructed by ( �/p� Address
Water Supply: Public.Supply From `''4Q� `a'r `^ `r,� ig'�o
Private Supply to be drilled by
Address
R 'rements
N
0
Square Feet
width trench
Other equ, , Is . -
I represent that 1 am wholly and completely responsible for the design and location of the proposed systems) ; 1) that the separate sewage disposal system
above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules an regulations of e Putnam
County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Health will
be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will
place in good operating condition any part of said sewage disposal system during the period of two (2) years immediately following the date of the issu-
ance of the approval of the Certificate of Construction Compliance of the original'system or any repairs thereto; 2) that the drilled well described above
will'be located as shown on the approved plan and that said well will be installed in accordance with the standards, rules and regulations of 'the Putnam
County Department of ealth.
Date �' Signed P.E. ' R.A.
Address VeAA License No,� r
APPROVED FOR CONSTRUCTION: This approval expires one year from the date Issued unless constructed of the building has been undertaken and is
revocable for .cause or may be amended or modified when co �ryby�Commissiopef-FP Health . Any change or alteration of construction
requires a new permit. Approved for disp� sanitary only.
By Title
Date
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