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HomeMy WebLinkAbout4057DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.66 -2 -56 BOX 31 04057 r)jr ri� - of l 04057 OWNEE SITE MAIL? PERS( •,• • 4 Pr= 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 `j eQai� �7 p��C Sys � 1��51�'' N12V D+AS +i uY\ Pt 1 tn.L�\ C, +4 X00 +o +t„, D e�S nr t ,w 3 t_! - . i g� Ts Inspector's V 4%07 Lqnature & Tit 0Z or, Y CoA /SrV4,r /-,Q Proposal Disapproved with the following conditions: . 6Z�L",?,f- - - Efate 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 camponents tied to two fixed points (e.g.,house corners). d. System description (e.g., 1250 gal. concrete septic tank, three precast 6' diem. 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. _ ptiPr SIGNATURE �`�°% ��G�c.• TITLE IXv PIES: Rdte (PAD); Yellow (Tam BD; Pink (Afttiamt) '• � �, it �. / � ° �. ,� r � r �� 1 J 4 ,�1'. t ��A �e � J a r j � 4. J • 1 r '' i JYs ME m womy - 4 ifv U 9'7 � / l .a S . .. .. •.. -U , ,° � ,.... it , � .. __ _ �",. F '� :. �:, '..t a4T �it�� b:.. Y'C � 1�Cay. -i�L. �. •41t ...0 ,!]5 "/ .: -.< i' .:S S .. d c� SE 17. 6 17r wipe C LC Cr - lz%' lo`' C1 r� e e � "a► certifications hereon are valid for the map and copies f :hereof only if said map or copies .bear the impressed 1 ' - Seal s rrvs,vnrpwhose, signature appears hereon." `t 9.41 'Weir F,CH E/WS., D 3e)V- Q N �o /,24t 103 t o � 2 4 D /6 /Y 3S� Ile � 1 i s1.477 � Zo � tia l l� F ice 0.05 ' 0.22E HBO i r 4 � v 2, STn�e," SURVEYED & PREPARED BY ALEXANDER BUNNEY LAND SURVEYOR. P.C. F,P�I M.E ALUM J /D //YG G.4.QAGE 2 ivrvEe o r14 E e.ET_ 3' SURVEYED & PREPARED BY ALEXANDER BUNNEY LAND SURVEYOR. P.C. 0 .Fier —.12f r 77G r o� w o . -..53,6 9D . S. W/7LL T. • - Face O'r p1/d�/ /00. 07' 0" la7c ST•PEET .2 0' o,� r� I&W,8. 7 /9�� J o � 0 .Fier —.12f r 77G r o� w o . -..53,6 9D . S. W/7LL T. • - Face O'r p1/d�/ /00. 07' 0" la7c ST•PEET .2 0' o,� r� I&W,8. 7 /9�� N> y 71 4 la LS... /YO. 120 7.-AlpoodgAV AZ OC/C d3, oS'�'C %" /O fY A ,+r aF 612