Loading...
HomeMy WebLinkAbout3893DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.16 -1 -27 BOX 30 *0 lot . M 19 i nt I SIM I ' '` 9 i �. L i r '; I ' - , . , . 03893 SITE MAIL] PERS( DATE PROPC 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. /90' ©f AACW SPIP 'IC- i�1FLD3 V w1DA WIM GOX65 c LclJ6n �o ti�y,R ��J�r�►ra /G wL'Z.Lj S. ._ Proposal approved � -- ._.. I + ~_K f .Proposal Disapproved � Yli H s Siqnature & Proposal approved with the followincr conditions: 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, Town and Tax Map number. c. Location of installed canponents 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. Wi -Z g$ to (e.g.,house corners). three precast 6' diam. x 61.deep 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 /Olc °,2 TITLE %11e)2 0 DATE G 11l e / PIES: WAte MD); Yellew (T,.vn Ell); Plink (Appl.icant) k tt j era � E (o�'o OWNgRe ILS! d� C o' hEw� 0f 600 N�:►v �E V g ;w ® a rte' v v `\ a e wA,I I-, �O �o46 FAoPasForl,�540s — foR L-/NPA 0-2,7 f; (;RooK poTH A M 1/AL-1-�Y N'Y'