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HomeMy WebLinkAbout3685DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74.17 -1 -14 BOX 29 INS- I q4, L i a, , T Sol r' N IS L IN ' -' r l 03685 19 Howard Grew 296 Oscawana Rd. Rub-Iam Valley, NY 10579 PHCNE SITE LOCATION SQ hILe R S r--- T A-MC �y MAILING ADDRESS P ,� ►J -�G ni� 41 �% X 41 L f y 04-Y . o j- 7 j PERSON INTERVIEWED MM Camplaint # Name & Relationship U.e, owner tenant, etc.) DATE (Q �'( q41 TYPE FACILITY Res , PROPOSED iNITALL6 . 1K PCE Se- ft J� Proposal (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. ril�4Scci�ar �- <�,,c -d1< Proposal appr.0 1 . 2. 3. 's A&Tuhl re & Title Proposal Disapproved wal approved with the followincr conditions: Procurement of any Town permit, if applicable. 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 components tied to two fixed points d. System description (e.g., 1250 gal. concrete septic tank, drywells surrounded by one foot + gravel). e. Installer's name and number. E? I-1 �Vf Date (e.g.,house corners). three precast 6' diam. x 6' deep 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. SIGMA ��S�i ? ' �.tJ'�t`-`� • : 4. , - TITLEr 1-1-1, DATE i� � � l PIES: White (PAID); YeUcw (Ttkin HI); Pink (ArpUa3nt) CO/j vsvf-:�)441L,� 45 �, 0�2 /� - S ?S- 803 S-+Orf.-,V\ V.] /f I � - v� 1-r i S!, v I 1� Q s C CPO 1:2111 11 '74. ql 42" •y �; o pd R�DIAr r 63 tb ­fm� IZ IA 4k ac 0 N17 CIL, O 1/ '4A of 0 Ol JO