HomeMy WebLinkAbout3680DOCUMENT CONVERSION SERVICES PROVIDED BY
IMAGING & MICROFILM ACCESS, INC.
www.scanyourdocs.com
631- 589 -8100
74.15 -2 -27
BOX 29
r 161
m k)6j
r 616
�,
4�
R.
PH=�
SITE LOCATION - T1# IS z 6t EO
MAILING ADDRESS
PERSON INTERVIEWED Pam) Complaint
Name & Relationship (i.e, owner,tenant, etc.)
DATE TYPE FACILITY
PROPOSED INSTALLER PHONE '9
Proposal (include sketch locating all adjacent wells):
NOTE: Repair must be in same location and of same type as original sewage disposal.sys.
Different location may require submittal! of proposal from licensed professional engineer =ar
registered architect. .
0
Proposal a : ova w± ;Proposal. PP
Disa K roved
Ins is Signature & Title
Proposal approved with the following conditions:
v� �'' ! 1
Date
1. Procurement of any Town permit, if applicable.
2. Submission of as built repair sketch in duplicate shaving:
a. Owner's name.
b. Site Street Name, Town and Tax Map number.
c. Location of installed canponents 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
drywells 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 agent of owner agree to the above conditions.
SIGNATURE TITLE & vi limp,
PIES: WAte MD); YeUc w (y+n ED; Pink (A pliamYt)
DAM � —7"
D
s
i
SCHOOL TAX I
MAHOP.AC CENTRAL FULL PAYMENT RECEIPT
APO PAC` CENTRAL SCH ;
SCHOOL OI,S.7RICT FOR TAXES
i�LSTRICT. OFFICE
TOWNS OF CARME'L',. AND
r 'LAKE YLEW'` D,R'I'dE
:q- TNAFI. VAL.L E
_..
_
= .:;;..P OP RIP IONc,::
. 77 .. .:, 77,
- _:,, -. -:.; , -..
3728;0o 6. - 3- .1I - *i
Ce
tf00D:;.5
ACR :ES
CLS. —:220. ROLL "SECT -1 .SCH-3T2001
,
HOUSE E LOT � 41
�'yhtl
40832
tf enr: 5chdl Dist,
EX N S I Awe +vuTMaal'.volley �. .
:EXEMPTIONS AG'Ep ALL mls 46
' TOW OF
T
',. ! `Pt1T1vABA VALLEY
V
' HAtiOTAC :CENTRAL
12,;940
6ti4 C
151.73'15.70
976.7.1
;. T OTi,
NE PAY�INt
I pAY `;! H
S `" ltQ_NY`
#
9 •Tl
78
I t; iLL C_OLLEC T
TA XES. N ` :T
E DISTRICT
OFFICE
AKEUIEb1 'SCH .'0
ltON' T.HRU FR
LAKE.1f EM '. R WAN
:C.EP KOL Y S: 'SEPT
Y' BETH EEN
q M, .S 31
::E
D
'f,
HRtl .00.T'
}
PARTIAL PA.YMEN
,.
$CHEOUt
I7H "2A, $'ER
ICE CHARGE
AgDEO
PART :IAL <.PYMT.. FEE :
i9.57
f:
PENALTY FREE PERIOD FOR FULL PAYMENT FROM ;.'�
09/b1/85 TO Q$ ®3Q�gS
I FOR FULL PAYMENTS FROM
10101/8S`TO 101,114
5 ADD .22INTERE
FOR PARTIAL PAYMENTS
INCLUDING SERVICE CHARGE:
FIRST HALF $
499.14 -DUE-NO LATER THAN 5
09 ii5�8
SECOND HALF $.
499.14 DUE BY'. C13:/ 5l86 TO 'COISM. OF FIYvIIl;NCE; :.
r
I (� T /�
I - ..LAIN 0u- JOnSEPH': L
-R D ? w a O L SI
S 11.909-1 �, 211
RECENEA4 AVIOU THE F LOCAL OFNEWANCETO BE
A
i'•M AHQ,PA�►.. ;NXI 1,054,1
ESTIMATED, STAFFAID ISM;
YORK DURING THIS FISCAL YEAR
AD RRECTI i
DRESS CO ON .
,I
AND NOTIFY YOUR LOCAL ASSESSOR
tf ,