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HomeMy WebLinkAbout3467DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73.18 -1 -36 BOX 28 03467 � , T .; ,. � IL % 1 9. . r � : _ t 03467 JUN-07-2004 10:30 PM SITE LOCH OWNER'S I MAILING A PERSON IN DATE_ PROPOSED I P.02 puTNAm COUNTY HFAITH DEPARTMENT iiV -13 10);- .&mt.-,yn �- cia's Z7 ZQJ& UNA-GIS nLVQRAL' LYAM RIUM r o OFMLAL UN ONLY E Z-cy FCHD Complaint# TYPB FACUrY. 1r'0.gd..6 &sO' pHO1,M !F24; -A$' 0;r;fiQ3TRA110N#_.yC1 PM12all (include skitch 1oc*t1zS all adjacent Welk): NOTE: Repair must be in same location and of same," as OdSM sewage disposal system -Differ mt location may require submittal of pfo posal from licensed professional engineer or regIsteLd architect. vier -C# r SIGNA -� PW=Sgl "=yed with the follovdag goditional 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, Towi and Tix Map number. C. Location of installed components tied to two fixed points (e.g.,housc comen). d. System description (e.g., 1250 gal. Concrete septic tank, three precast 6! diem. X & deep C. Installers' name and number. .3. System repair to be performed in accordance with the above proposal and conditions. Proposal appmved� Invector's Signature & Title COPS: Wbite-(PCHD); YOUQW (Town BI); Pink (epplkpf) PC-RP 99ML DATE