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HomeMy WebLinkAbout3549DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74. -1 -24 BOX 28 � 11 f � � � t r r�. IN 6 ` T IN f r N :' � '� IN 03549 t l PERMIT #PV -5 -81 PUTNAM COUNTY DEPARTMENT OF HEALTH S01927 Division of Environmental Health Services, Carmel, N. Y. 10512 CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM Putnam Vall�v ri Cdcilted at • ~'�Gu�- Tax Map . 62 Block 10 Owner McGlasson Builders Inc. Tax Map Lot # 12 subd. # 37 Separate Sewerage System built by Owner Address 93 G1 enei da Avenue' Consisting of 1000 Gal, Septic Tank and 426 L. F. x 94" Wi"dP TrPnrh Other requirements None Water Supply: Public Supply From _ X Private Supply Drilled By Address Building Type Modular Has Erosion Control Been Completed? Yes Boyc Rte. rtesian Well Drillerrs 2, Lake Carmel, NY 10 No. of. Bedrooms Three Date Permit issued 3/23/81 Z 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, in accordance with the filed plan, and the permit issued by the Putnam County Department Of Health. Date 8 June 1981 Address R • D • 9 Certified by Pair Xr et, Carmel P.E.' X R.A. � License No. 29206 Any person occupying premises served by the above system(s) shall prArptly 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 public water supply becomes available. Such approvals are subject to modification or change when, In the judgment of th missloner of Health, such n, modification or change Is necessary. Date — I 4, A —• By Title V / PUTNAM COUNTY DEPARTMENT OF HEALTH i �13 '( l:ivhrion of H -Salth SOrvi:0-t. Carmel, N. Y. 1051 2 01. 27.. CONSTRUCTION`PERMIT FOR SEWAGE DISPOSAL SYSTEM Boswell Road Located at Subdivision- Boswell Estates, Sec. "B" , Lot #37 Owner McGlasson But1ders, Inc. Building Type Modular Lot Area 1.001 A. Number of Bedrooms Three Design Flow 600 Gal • - Separate Sewerage System to consist of 1000 Gal. Septic Tank -- To be constructed by Owner Water Supply: Public Supply From Private Supply to be drilled by ? -© p I�' Address Other Requirements None Putnam Valley To Ilage Tax Map 62 Block 10 Lot 12 Job 501997 Address 93 Gl enei da Ave. Carmel NY 10512 j Total Habitable Space r 1 6Q Square Feet and 429 L, F . x 24" wide trench S own Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s); 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 regu a ions o e rutriall, County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill 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 regu a ons of the Putnam County Department of Health. 16 March 1981 P.E. X R.A. Date Signed Address R.D. 9 a,. �License�No. 29206 APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unless construction of the building has been undertaken and Is revocable for cause or may be amended or modified when considered necessary by the C ner of Health. Any change or alteration of construction requires a new permit. Approved for disposal of dome starrry sewage, nd /or rivate r supply only. 7 _ .. di a iA �.\ sue_ NANCO ENVIRONMYENTALSERVIC�ES,.:I -NyC { HOPEWELL JUNCTION, NEW YORK;12533 . (914)221- 2485 aicG at Bpi er-s: -i ._ s: :NAME � = _ - VATO FlEC 111)Gi) � — — ADDRESS. Will Pick-Up b I�1 - = - TIME SST SAMPLING - PO (NT' Tara " n ma3� r TREATMENT=:CHLORINATED ❑( SOFTENED ❑, OTHER ❑ 'SOURCE: DRINKING WATER ❑ WASTEWATER EFFLUENT.El OTHER; , z AM C(1LLECTED' BYt`eia,�ra TIME P M DATEi� - � ?4 13 APARTMENT COMPLEX `.' y O'INSTITUTION r0 FRIVATE'RESIDENCE ❑SWIM POOL q BEACH ❑ MUN(CfPAL El, RESTAURANT - .13 TEMPORARY RESIDENCE p CAMP O NURSING HOME D' SCHOOL_zt ❑TRAILER PARK D %FQRM' LABOR ' CAAAP ` 0 PRIVATE COMPANY D SEWAGE TREATMENT PLANT ❑OTHER D TOTAL COLIFORM COUNT M F.T. - PER 100 M.L.- ❑ TOTAL COLIFORM COUNT M.P N: '- PER 100 M.L. O -FECAL COLIFORM COUNT M.F.T. - — PER 100 M.L. =❑ FECAL- COLIFORM'COUNT M.P N, PER 100 M. L.% 0 - FR02EN DESSERT PLATECOUNT' " O AGAR PLATE COUNT PE M.L. zzu i BORA O.Y: ICIAN D TE PORTED; R REC of :I LA ,IOA o THAT INA'� �.r � 0"010 Nth MICE f ATISFA "'Al # p s ,fit'1f l # 1,t t3 Iii Eta Tt? kAmpo a �� '� b F'''� � ° °de � f. � .,_•.,' �: ^'s '� U^ h %o..,,t' xo- ��' -ri � � +J:�'o �' 3 �S' c,+-r_"{Zi' ;. `. ." ..!� -, :. ;r n _y,.,.^.:_'^_ - '�"uz_ -` .:fin �^ . ��L..:c= - -_.:�-��;:x .�- ....¢s•-�..�.: -d,r- - ya�+>-c ��r: � - c .L,. :..n- c�;�- _:--- - =�:._. -. -, _ ..o - 2 a c 1° 4 � SHERLITA AMLER, MD, MS, FAAP Commissioner of Health iw�ratJ •�.., •. '.�v I ,i_` - —.. ^�.. .. •t .W'i'g. ♦ -, LORETTA�MOLINARI, RN, MSN Associate Commissioner. of Health ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health DEPARTMENT OF HEALTH a 1 Geneva Road, Brewster, New York 10509 r ADDITION APPLICATION. RESIDENTIAL ONLY \ STREET ��Sw ��-�— TOWN ?NAM yA4j- C/.TAX MAP# NAMFt-t" ' NA-A4 �/ �4 PRONE PCHD# Iq ^ ' MAILING 22 ' f �/ /o � 7i ADDRESS 5 !J oS W 4L iClj - �v l ��� V y I jn_F DESCRIPTION OF r ADDITION -it 5 if a o `iN L NUMBER OF EXISTING BEDROOMS 3 PROPOSED # OF BEDROOMS Nd> oJ6 (FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR) "Any addition-which is considered a bedroom requires formal approval of plans (Construction permit) prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the Putnam County Sanitary Code. Please submit this form and the following to Putnam County Health Dept., 1 Geneva Rd, - Brevistcr; NA' -10509, PYione .(a_4.5)•27F= 1 s;;... _. _: _ :_. _ _ 1. Certified check or money order for $100.00. 2. Sketches of existing floor plan (drawn to scale, all living area including basement) 3. Two sets of proposed floor plan (drawn to scale with name,, street and tax map #) *Non- professional sketches are acceptable . /4. Copy of survey showing well and septic locations to the best of your knowledge. Include date of installation if known. Label all wells and septic systems within 200 feet of the property line. Contact this office with any questions. 5. Copy of Certificate of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. OFFICE USE COMMENTS Environmental Health x(8.45) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 2.25 -5186 Fax (845) 225 -5418 Nursing Services (845)'278-6558 Faz (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 r � SIIERLI(TA AMLER, MID, Ms, FAAP . LORET'TA MOLINARI, RN, MSN Associate Commissioner of Health. DEPARTMENT OF HEALTH 1 Geneva Road; Brewster, New York 16509 ROBEJU J. RON. P1. (:o �zecutive'� Town Legal Bedroom Count. i, Re: T I A C E N T6_ (Owner's Name) Tax Map #: Address: 54 - E L L• jZ-r . Town: yl 1_ N A nA_ . V R U Year Built: _ Accord in to records maintained by the Town, the above noted dwelling, is in mp co liance with Town Code. is not in compliance with Town Code. = :..The Legal Bedroom 6Count is: This information has been obtained from: Certificate of Occupancy: v ��`� t �0.►'� Other: Building Inspector I a 1111.9 Date Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 McGlass.on Builders, Inc. �4 4 aaoT iiunibipality' Owner Bj;� Xcj Ift$ Co'AstructZ4 by Boswell Road PRET64 Modular TM 62 - Boswell Estates Subd., Sect. "B" do on 10 .12.- Subd. Lot #37 L P GUARANTY OF SEPARATE SEWAGE. SYSTEM rpprosent that .I am wholly .and completely respQppibje foil the jQcqt .on„ workmanship, material, construction aad*dr4inage of the sewage disposal sy4tem serving the above described property, and that it has beara constructed as shown on the approved plan or approved amendment thereto.. and in accordance with the standards, rules and regulations of thp Puinep County Department of Healtl-•, and hereby gu,arar_t; to the owner, him OV.0pes . - sl9pa, . heirs or, assigns * to place in good operating condition any part of acid 4ygtem constructed, by."Pie which fails to operate for a period of two yqars immediately following the date of initial use of the sewage dispopal pypt . em, or any repairs m qd e by me to such h syster , except where the fa lur to operate properly is caused - by the willfu*.l or negligent.act of the occu- pant of the building ut--ilizing the systexr,.* The u4dersigziad, further agrees to accept . as conclusive the do- termination of the Director of the. Division of EnvIronriental Health 41ap- vices -of the Putnam County Department of H a a.1 t h -.as -t the. -to whether or A IjAr '61.8 a a�- i Act of, the occupant or the building utili4lng the SY pgtO Wa 8th day of June 19 81 5igriatqrs Title -1 tir corporation# g vo name and address) McGlasson Builders, Inc., 93 Gleneida Ave., - -- - - - - - - carn%V* NY 705-1 Z" THREE (3) QQPT9S ARE REQUIRED WITH TURE2. (3) COPIE. 3 OF FINAL PL4NS. P.PFORE CFRTjFTQ4T4 0,.F COWLETION WILL BE ISSUED GUARANTOR IS RE LIRF�D TO FILE. NOTICE OF DATE OF FIRST USE OF SYSTEM. Dlviaipn of Environmental Health Services, Puti-iarri County Department o:r 19pg1th D SHERLITA AMLER, MD, MS, FAAP Commissioner of Health .�' - ' �•'•'LORETTA''MOLINARI;�RN; �SN �� "Y'"" Associate Commissioner of Health ROBERT J. BONDI County Executive _s ,......�..�.�..,..1OB6 MORRIS;'1PE`.. ,�.=. Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 January 6, 2009 Mr. Piacente 54 Boswell Road Putnam Valley, NY.10579 Re: Addition- A7001 -09 No Increase in Number of Bedrooms 54 Boswell Road _(T) Putnam Valley, T.M. # 74.4-24 Dear Mr. Piacente: I have received and reviewed the plans for the proposed addition to the above - mentioned residence. The proposal for the addition'has been approved as per plans bearing the approval stamp from this Department dated January 6, 2009. The audition is approved 'A Lhe following conditions: 1. The total number of bedrooms must remain at three without prior approval by this Department: 2. The area of the existing sewage disposal system and its expansion area must be maintained: •v..�.- ......au...- �...�r r ..- .._ - ..- ..�..- w .. _..e - .aDC^.._ .n. ... ... ..+_......._. - ».Y.a +w. -....�...- ....ww.�y0 �.-a, ww.r.� . ....-- .... -.. �..- ... .r w• >� -._ .w .. .... r--.• 3. All plumbing. fixtures must. be updated with water-saving devices, i.e., new low flush toilets, restrictors for shower heads and faucets etc. . 4. The approval is for the proposed changes only. This approval does not validate any construction shown' as existing that has not obtained proper approvals Any other permits or variances required are the responsibility of.the applicant and the jurisdiction of the Town of Putnam Valley. If you have any questions, please contact me at (845) 278 -6130, ext..2261. 4 a With N,(, Sincerely, Gene D. Reed Senior Engineering Aide GDR:kly cc: BI, (T) Putnam Valley Environmental Health (845) 27 &6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845)225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 McGl ass.Qn $uilders,. -jnc.,,- Owner jTu- Boswell Road: Pda'U04 7; -1 0t*-q6X7 -Putnam.- 4-alp .L TIMM pa TM 62 Boswell Estates Subd., Sect. "B" 10 7BI P 5 x. Modular 12.- Subd. Lot #37 GUARANTY OF SEPARATE SEWAGE-SYSTEM I represent that am wholly .and completely re� iponpible, fop the locgtlon, workmanship, material, construction and drainage of the s evagip disposal system serving the above described property, and that it has been constructed as shown on the approved .. plan or approved amendment .. thereto, and In aoqQr44nqe with the standards, rules and regulations of the Putnam County Department of Health and hereby guaranty to the owner, his suope spra, heirs or assIgns,, to place in good operating condi.tion any part of said system constructed, by m® which fails to operate for a period 1. of tiro years immediately follo-wing the date of initial use of the 'e *sawa g disposal system, or any repairs made by me to such system, except where the failure to operate properly is cauaed by the willful or negligent, act of the occu. pant of the building utilizing the systor.. Tho undersigned fiirthe'r agrees to accaL)t as conclusive the de- termination of the Director of the. Division of Environmental Health 41ap- vices -of the Putnam. County Department of Health as to --Z whatte._or p t:.- -ox Sir t of the . oopu ant, of the building utillzing- the syst m 400 this 8th da' of June 19' 81 signature Title 'Ur corporation,,, gTVe and address) McGlaston Builders, Inc., 93 Gleneida Ave., - Cgrnrel"" RY `10512"' THREE (3) COPIES ARE REQU-IR4D WITH THREE (3) COPIES 0 FINAL PLANS E F CERTIFICATE OF COW.LETION WILL BE ISSUKD. GUARANTOR IS REQUIRZD TO PILE NOTICF OF DATE OF FIRST USE OF SYSTEM. jXviPiQn Qr EAviroamental Health Services, Putilarn County Department of No4ith WELL; - COMPLETION', REPORT.' . PUTNAM COUNTY DEPARTMENT OF.HEALTH • 3/1T ti D'vrsiti'n of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK. This report. is to be completed by well driller: and submitted to County Health.. Department topther with laboratory report of Teal siso.# wa *_Rr_sannple l�dreatinq �aater,.ls Gf Satlsfagory Wagiai- quality. efore certificate of,' construction compliance iS. issued _ 4;:.j9 >,• m H a.. :'^'4'.. R+tr <t}. . h'C•le T Ly. %a +n•,:. :a. v,...:;'�i.. " "r!4 T: %�:i..Y o• " -a�vC }Fria%. ., t' REPORT MUST BE SUBMITTED, WITHIN.30 -DAYS OF WELL COMPLETION -- LENGTH (feet) DIAMETER(fncbea)' WEIGHT ER ., CAfIN© ("�� a1TA`as . 280.' 6" 19 'I b s C J THREADED Lj WELDED YES D NO LN YES LJ NO HOURS YIELD (G.P.M.) } 1rIBlD a Bl D PUMPD •. COMPRESD A •3O tEn , O 8 MEASURE FROM LAND SURFACE STATIC (SpecUy`feet) DURING YIELD TEST (feet) Da T', Y Id dIf 010 f ooin f bw edsrfdrw own uoto to I 4351 MA KE IENGTH OPEN TO AQUIFER (INt) •ii, GRA El':SIZE (lnehea) OM (toot) TO (leaf) 'z D6TAfli $LOT SIZE DIAMETER (lnchea) IF. GRAVEL Diameter of well including s -PACKED: .gravepeek '(Inehba): pRPTtI FtpM LAND SURFACE ' Slteteh exect loe�tlob of well with d $tarieea, to of least ' - FORMATION: DESCRIPTION two permanent landmarks. FEET; i "FEET NerburAen " 35 l estone- oam �.��� '" _.y,.�o_ . -- a y.r _ ..,.. _• .pp:. ,�,,, ,...:.,:J q •.�; .F ....... • t e.tL .� . f'.,.., , r 1 , If yield was tested at difF.rent depth; during: drillinp, list below: - FEET GALLONS PER MINUTE eY r •W LL COMPLETED' �. ;} _•.;.. DATE Of.REP,ORT WELL 0, E { NAME ADDRESS owRek �. on �Bui,l'ders lnc. McGtass � '- ' 93',GI'ene i da Ave. Carmej N.Y.. LpCAT10N (No 6 reef) (Town) . OP WrdL B.oswet Road Putnam Valle , trROPOSED', - ljj.J DOMESTIC .' BUSINESS CJ- ESTABLISHMENT k, C�,FARM CD TEST WELL y D'INDUSTRIAL 'CONDITIONING Q'(S f SUPPLY pRIL1ANti . ; []'ROTARY a COMPRESSED D E]: OT ER , ;� •, PM6NEdU PERCUSSION -- LENGTH (feet) DIAMETER(fncbea)' WEIGHT ER ., CAfIN© ("�� a1TA`as . 280.' 6" 19 'I b s C J THREADED Lj WELDED YES D NO LN YES LJ NO HOURS YIELD (G.P.M.) } 1rIBlD a Bl D PUMPD •. COMPRESD A •3O tEn , O 8 MEASURE FROM LAND SURFACE STATIC (SpecUy`feet) DURING YIELD TEST (feet) Da T', Y Id dIf 010 f ooin f bw edsrfdrw own uoto to I 4351 MA KE IENGTH OPEN TO AQUIFER (INt) •ii, GRA El':SIZE (lnehea) OM (toot) TO (leaf) 'z D6TAfli $LOT SIZE DIAMETER (lnchea) IF. GRAVEL Diameter of well including s -PACKED: .gravepeek '(Inehba): pRPTtI FtpM LAND SURFACE ' Slteteh exect loe�tlob of well with d $tarieea, to of least ' - FORMATION: DESCRIPTION two permanent landmarks. FEET; i "FEET NerburAen " 35 l estone- oam �.��� '" _.y,.�o_ . -- a y.r _ ..,.. _• .pp:. ,�,,, ,...:.,:J q •.�; .F ....... • t e.tL .� . f'.,.., , r 1 , If yield was tested at difF.rent depth; during: drillinp, list below: - FEET GALLONS PER MINUTE eY r •W LL COMPLETED' �. ;} _•.;.. DATE Of.REP,ORT WELL 0, E { �. ;} _•.;.. DATE Of.REP,ORT WELL 0, E { e PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH- SERVICES - -- - - - ' ,•��.; rit -. -.� -.� .- .:�5:..- •. --.n.. �s _ . _� .. .. - . . 1. •C- .•:.,fit Date 29 October 1980 Re: Property of McGI asson Builders, Inc. Located at Boswell.Road, T. Putnam Valley Section 62 Plat II Block 10 Lot 12. Gentlemen: Boswell Estates Subd., Sec. ".B ", Lot #37(641,14108(9) This letter is to authorize John H. Prentlssg PE,, a duly licensed professional engineer X or registered architect (Indicate) to apply for a Construction Permit for a separate sewage system; to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and. to sign all nece$sary papers on my behalf in VV1111CL L.LU11 w1 Lfl LlUb ma L Vier anU to. supel'vise the cunstruc ciun of said system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam ;County :Sani-... -.- - -I rCod'e P.E., R.A., # 29206 R. D, 9, Fair St. Address Camel, DIY 10512 914- 87"Ll70 Telephone Very truly Sij 914 - 225 -7964 Telephone THE OFFICERS SHOWN ON THE CORPORATE AFFIDAVIT (M FILE 141TH THE PMAM COUMTY. HEALTH RPMEHT 4i ,AVE. PINT BEEN MAN UCH FILING. 4 C o -/' - A PUTNAM COUNTY DEPARTMENT OF HEALTH s o I q ;j DIVISION OF ENVIRONMENTAL HEALTH SERVICES- BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM;.,' FILE 140. Owner ' McGl arson Builders, Inc. Address Boswell `Rd. Located at (Street Sec. Block 1'Q. ; Lot 12 _ -.,6dicate nearest cross s ree ~ Subd. Lot 37 �ilQIh3t?g� l V Putnam aley Municipalltg.. Watershed' SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Ole 4 Number CLOCK TIME PERCOLATION PERCOLATION Run apse Depth to Water Water Level. .No. ..:.......:.....: :.. " Time From Ground Surface in Inches - Soil Rate Start -Stop Min. Start Stop Drop in Min./in drop Inches Inches Inches 4 e rs-f- 11/ /B4 Notes; .1) Tests to be repeated at same depth until approximately equal soil l�ates._:a�e:_ bt .nEu.:4t eac� -p�rco sty on test :•hole :., A -deli —to W aubm :ttr�e2. for reviewe 2) Depth measurements to be made from top of hole. :� DEPTH G.L. TEST PIT DATA REQUIRED TO•BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES.. HOLE NO.- HOLE NO HOLE NO. 4. THIS S-PACE -FOR-USE- BT-HEALTH DEPARTMM-T ONLY: 0. � Soil, Rate Approved e Sq. Ft/Gal. Ch 29'� 119 A I. Date - ^ . Structure located from survey by siii rwayors survey.— Well located ire "i inspection 61 Pield -Health-44p Ae Of G /lzsT rtoov_ (100 c/1A&)",6S) Sy BOSWE41, TO.41> PvTn1AM VOI.1 -1- EYi A) y 10.7 5 TM,4 7/1, - / - 241 (�j E�ZOOM s 13 AT 7 ` PUFNAM COUNTY DEPARTMENT OF HEALTH HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY 3 ,4 - °o 0, -o BE D ROOMS 9 T/W 7'f, -! ALL SUBSEQUENT REVISION /ALTERATIONS TO THESE HOUSE PLANS MUST BE SUBMITTED TO THE PCDOH FOR APPROVAL SIGNATURE &TILE DATJE C_os�� =C (3f-r7' >•I)2oom PoTF_HTtAE7 BE mr-r 51 f� f' 4 CLosF� o o wrr I � $�7 POTENTIAL 3� 3P(ti f... Rooms . i I N � yJ i N D Ov✓ I f K ►TcNc-1 �R C, t I �? 4k rl 4fe5 Z u. _t V r Ali �I r. 3, i { 41• t n t —(-- Lno/Z Q R , rA AftA f. 11F-(o if } L'+ R g� :f W f N Dc�,✓ { FAOO f" S' n rt I 5 -0 — J. 'r• i i U���tl� 1 I , PLUNAM COUNTY DEPARTMENT OF HEALTH i 5/31 S I HOUSE PLANS APPROVED FOR BEDROOM COUNI ONLY a Cl _3 BEDROOMS A`ooI - o'j i I 7-We %N1 SUBSEOUENT REVISIWALTERATIONS TO THESE HOUSE J �� PLANS MUST BE SUBMITTED TO THE PCOOH FOR APPROVAL SIG TU SIGNATURE & TITLE / ATD E - n � o[I ,i I Mkt f i •' i 1 wthti70 W 1 S 6 9 !! li � iIi e� I ` r 'r A � f b Y r c� m ti 7-8 , b,n DO vi _ -_-___ lullAl%Owy !! `T-(o Sir D�f G p- 111 IX I ` �Xt��T /NG CLO W wlNno✓. � w b0,,/ I tlF)JA•J� , R' { Fi1zsT FLoo� o O t•1 I i k►TcNr'� IoM AXICA 'Fro �R Cios�.� Foe �5�o SK �_� •. ,; r' � 3P(� CZa o+•1 I z v. (ZooM (W 7' �t � ,� 1,11 � 4 /% /f / ` r•' � i IaFr cn yJl��a„✓ ,� Y I I. w(Nno.) i aaoa, W�NDt7�/ Dpok • ! I 8x157' /,V4 - 34Si-1VEn7'T 5,/ goSavELL 7ztxp " Pv-rn/p Al vAlG, y, ,� y, I o S> q -r/l,# 71f, - / - zy