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BOX 30
No 9
16
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LEONARDO & SON CONSTRUCTION, INC.
OWNER: LOUIS LEONARDI
6 CAROLYN DRIVE * CORTLANDT MANOR, NY 10567
- - .1 i '.. . .. j1(914)-,-736;9010 . :... - -
LIC..#WC-3112-H90 - WC- SEPTIC LIC. #00067 - LIC. #PC-560 (CERTIFIED)
PROPOSAL SUBMITTED TO PHONE DATE
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STREET. JOB NAME
CITY, STATE and P 7 JOB LOCATION
f.-
ARCHITECT Ott 0. -PATE OF PLANS,
..............
We hereby submit specifications and estimates for:
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Of Pages
JOB PHONE
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PLEASE NOTE: *SYSTEM LONGEVITY IS NOT GUARANTEED UNLESS DESIGNED BY A LICENSED PR6FEEsIML ENGINEER.'
*TANK TO BE PUMPED BY OTHERS AND PAID SEPARATELY.'
*NO LANDSCAPING RESTORATION, OTHER THAN GRADING DISTURBED AREAS, IS INCLUDED UNLESS SPECIFICALLY sTFma-
fle FrOPOSLI hereby to furnish material and labor complete in accordance with above specifications, for the sum of:
dollars ($
Payment to be made as follows:
A FINANCE CHARGE OF 1%% PER MONTH WILL BE ADDED TO ALL UNPAID BALANCES.
CUSTOMER IS RESPONSIBLE FOR'ANY AND ALL COLLECTION FEES.
ALL DISPLITES ARE TO BE SETTLED THROUGH BINDING ARBITRATION.
All material is guaranteed to be as specified. All work to be completed in a workmanlike
manner according to standard practices. Any alteration or deviation from above specifications Authorized
involving extra costs will be executed only upon written orders, and will beco me an extra Signature
charge over and above the estimate. All agreements contingent upon strikes, accidents
or delays beyond our control. Owner to carry fire, tomado and other necessary insurance. Note:.This proposal may'be
Our workers are fully covered by workman's Compensa . tion Insurance. withdrawn by us if not accepted within days.
Acceptance of proposal — The above prices, specifications
and conditions are satisfactory and are hereby accepted. You are authorized Signature
to do the work as specified. Payment will be made as outlined above.
Date of Acceptance: Signature
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AS BUILT DRAWING
76 Ri ��F� -rtes4
W_e_ Pe-e� 5 Ell It
Leonardi & Son Construction, Inc. Date:
6 Carolyn Dr. Cortlandt Manor 10567
(914) 736 -9010
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76 Ri ��F� -rtes4
W_e_ Pe-e� 5 Ell It
Leonardi & Son Construction, Inc. Date:
6 Carolyn Dr. Cortlandt Manor 10567
(914) 736 -9010
SITE LOCATION_
OWNER'S NAME
PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR
OFFICIAL USE ONLY
MAILING ADDRESS --1 Ls? 1 --% n C, c- �r'eS-\-
SI
PERSON INTERVIEWEDI_ PCHD Complaint # Y N &/l
dame Relationship �I.e., owner, tenant, etc.
DATE � � � � � -5 TYPE FACILITY
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PROPOSED INSTALLER &—o v� Cz—rci � �, Soh C ten_ c PHONE y' /� i 6 P01-0
ADDRESS Co La- r p I,, V,- 0,,--HA P I+ 11 &or REGISTRATION# PL- S
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.
I, as owner, or reported agent of owner agree to the conditions stated on this form.
SIGNATURE -� Q — �� TITLE CXJ- i(Z' V— DATE [ J
Proposal approved with the following conditions:
Procurement of any Town permit, if applicable.
�t5Submission 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 (e.g.,house comers).
d. System description (e.g., 1250 gal. Concrete septic tank, three precast 6' diam. X 6' deep
e. Installers' name and number.
3. System repair to be rformed in accordance with the above proposal and conditions.
Proposalapproved
pector's Signature & Title
COPIES: White (PCHD); Yellow (Town BI); Pink (applicant)
PC -RP 99ML
Y II /0 S"-
DATE