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03778
FROM : Rye Brook Building /Engineering PHONE NO. : 9149395801 Jun. 10 2004 08:15AM P2
JUN-- 0-2004 13:06 FRAM :P!.1T,NAM COUNTY CEP*..- 645 -279 -7921 �0:'S15i�9315�•kJ f':;'1
C PUTNAM COUNTY BEALTH DEPAki-l—Ei4T
DWISION OF E:YVIRONYIEI"UAL HEALTH SERVICES
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0M- CIAL USE OKY
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srm LOCATION 22- 6-166654r Gee 1 ?41, TMO 3 z t>,,
OWNER'S ONR
A4ZING AWRESS Z 2 Gi' L /.x � z_ r G ►� !a �► y"� -4<-• vim" /� y C'a_S- 7
PERSON ENTiERVIE'WE.iD ICED Complaint #_ _
Rank 3Flte nn ip i.e., awnet, i`*ti�'ecsT-
DALTE, r/ o TWE F kcpay % _ _lam f e-
PROPOSED L'NV 5 L'IER e G F PHONE--9 <'V `� o �- �!`8 J 6 - _ --
ADDRESS-4LZ 6 69cvi r Z-v4�4—' F?y ...R.EC3ISTRATIOM --
Pmpawl (include sketeh locating all udiacent wells):
NOTE: Repair must be in saute location and of same type as origbW sewage disposal system .I 'went location
may require subrnititl of propamd from licensed prvfasional englnacr or mgistered arabiiwt<
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I, as owner, or reported agent of owner ague to the conditions stated on this foam.
1. Proctutment of any Town permit, if applicable.
2. Submission of as built regain sketch in duplicate showiaV
a. Ownea''s naa ie
b. Site Street Name, Town and Tax Map number.
c. Location of fiwtBS.led components tied to two fixed points (e g., ouse corners).
d. System, description (e.g,, MO gd. Cotwxete segdc tattle, tbrce gmaast 6 diam<
e. .Installers' nme and number.
3. System rep W^ to be pe ormed in accordance with the above proposal and conditions,
yrnposal appmvea
bVa:tor's Silpatarc & Title
COPIES; White (PCOD); Yellow (Town SIB; Pink (applicW)
PC -RP 90MI.
JUN -11 -2004 FRI 08:58 TEL:845 -278 -7921
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DATE •
NAME:PUTNAM COUNTY DEPARTMENT OF P. P
FROM : Rye Brook Building /Engineering PHONE NO. : 9149395801 Jun. 10 2004 08:15AM P1
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VILLAGE OF RYE 13ROOK
MAYOR 938 King Street, Rye Brook, N.Y. 90573 ADMINISTRATOR
Lawrence A. Rand (914) 939 -0668 Fax (914) 939 -5801. Christopher J. Bradbury
www.ryebrook.orgr
TRUSTEES
Richard C. Buzin
Joan L. Feinstein
Robert G. Harris
Dean P. Santon
Jude 11, 2004
Dear Mr.Luke,
CODE ENFORCEMENT
OFFICER
Hector O. Boscarino
I'm faxing you the information required. I'll check with the inspector in Putnam Valley and if a
permit is needed I'll pull one a and send you a copy. .
Re: 22 Gilbert Lane
Putnam Valley N.Y. 10579
Please let me know what the fee is acid I'll get that to your office A.S.A.P..
Th you,
Hector Boscarino
JUN -11 -2004 FRI 08:58 TEL:845- 278 -7921 NAMFePIITNAM r•niiKi -ry nrAr%Lirmr.oT - .
FROM : Rye Brook Building /Engineering PHONE N0. 9149395801 Jun 10 2004 no:—nM P
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JUN -11 -2004 FRI 08:59 TEL:845- 278 -79
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