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83.81 -2 -42
BOX 32
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04241
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DEPARTMENT OF HEALTH
Division of 'Environmental Health Services
4 Geneva Road
Brewster, New York 10509
TeL (914) 278-6130 Pas (914) 278-7921
PROPOSED ADDITION APPLICATION (RESIDENTIAL ONLY)
BRUCE R FOLEY
Public Health Director
STREET 4/f RECk CQ TOWir',(A, -& TX MAP #
NAME PHONE -4, 9- :5?9y PCHD # J�
MAILING ADDRESS d9- �k'r'2 s7 11fke G'F��'kY1.4
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DESCRIPTION OF ADDITION A-x60wmcrG' BFD 0?W 4- F) Vl,/ 6*ffPd' 1t
,_NUMBER OF EXISTING BEDROOMS PROPOSED # OF BEDROOMS
(FROM CERT. OF OCCUPANCY OR
CERTIFICATION FROM BUILDING INSPECTOR)
*Any addition which is considered a bedroom requires formal approval of plans (Construction
Permit) prepared by a Professional Engineer or Registered Architect in accordance with
,applicable sections of the-Putnam County- Sanitsry Code.
Please submit this form and the following to Putnam County Health Dept., 4 Geneva Rd.,
Brewster, NY 10509, Phone 278 -6130.
1. Certified check or money order for $100.00
2. Sketches of existing floor plan (drawn to scale, all living area including basement)
* Non - professional sketches are acceptable
3. Two sets of proposed floor plan (drawn to scale, with name, street, and tax map #)
* Non - professional sketches are acceptable
4. Copy of survey showing well and septic location, to the best of your knowledge. Include date
of installation if known. Label all wells and septic systems within 200 feet of the property line.
Contact this office with any questions.
5. Copy of Cert. of Occupancy from Town or Certification from Building Dept. with legal
bedroom count of dwelling.
OFFICE USE
Comments
Feb 98
PUTNAM COUNTY DEPARTMENT OF HEALTH—-
HOUSE PLANS APPROVED FOR
q r BEDROOM COUNT ONLY;
( -) P 3 BEDROOMS
Signature & Title . Date
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PUTNAM COUNTY DEPARTMENT Of HEALTH. .
HOUSE PLANS APPR0VED FOR
BEDROOM CO.UNT.ONLY ;.
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Signature &Title Date
BUILDING
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BRUCE. R.. FOLEY
` "''Pualtc'alth Director' -
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, A1ew York 10509
LORETTA. MOLINARI RN:,•.M -S -N:
Associate Public Health Director
Director of Patient Services
Environmental Health (914)278-6130 Fax (914) 278 - 7921
Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085
Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648
May 16, 2000
Raymond Rodriguez
48 Becker St.
Lake Peekskill NY 10537
Re: Addition- Rodriguez - Becker St.
No Increases in Number of Bedrooms
(T) PV Tax #.83.81-2-42
Dear Mr. Rodriguez:
I have received and reviewed the plans for the proposed addition to the above - mentioned
residence. The proposal for the addition has been approved as per plans bearing the approval
stamp form this Department dated May 16, 2000 The addition is approved with the following
conditions:
1. The total number of bedrooms must remain at three without prior approval
by this department.
...Tho area:of-the existing:sewagP ,disposal system;. and its expansion area, muss be
maintained.
3. All plumbing fixtures must be updatedwith water saving devices, i.e., new low
flush toilets, restrictors for shower heads and faucets, etc.
Any other permits or variances required are the responsibility of the applicant and the jurisdiction
of the Town of Putnam Valley.
If you have any questions, please contact me at your convenience.
Very truly yours,
alL
.114
Michael Luke
ML:kg Public Health Technician
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All certifications hereon are valid for this
JOHN SALVATORE ROMEO
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a and copies thereof only f aid ma
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opips bear the impresx.d sent of the Sur,
veyor .+hose signature appears hereon. f
1 NORTHRIDGE ROAD
PUTNAM
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PEEKSKILL. N. Y.
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"It is hereby crrtiiu•d that this survey .+es 6
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Coo... Fr.:: ::c :- 4- land Survevs adopted
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P. E. & L. S. NYS LIC. NO. 027846
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by the New York State Association of Pro }
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feuional Land Sur- v."."
ENCROACHMENTS BELOW GRADE IF ANY NOT SHOWN
SURVEYED
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