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Town of Tusten 210 Bridge Street PO Box 195 Narrowsburg, NY 12764 Phone: 845.252.3310 / extension 14 Fax: 845.252.7509 Sewage Disposal Permit
Date of application: __________________________________________________________
Name of Owner: ______________________________________________________________
Address: __________________________________________________________________
Phone: _____________________________________________________________________
SBL# _____________________________________________________________________
Contractor: ________________________________________________________________
Address:___________________________________________________________________
Phone:____________________________________________________________________
Type of Building:(eg. single family, duplex, etc.)
__________________________________________________________________________
Location: (IF DIFFERENT THAN ABOVE)____________________________________________________________________
Estimated Sewage Flow: ___________________________________________________________________________
Percolation Rate: ____________________________________________________________
Deep Pit Test Soils Log:
___________________________________________________________________________
Special Conditions:
___________________________________________________________________________
ALL SEPTIC SYSTEMS MUST BE DESIGNED BY A NEW YORK STATE LICENSED DESIGN PROFESSIONAL
PERMIT Permission is hereby granted for construction of the above system.
Fee Paid($50.00) ____________ Check__________________________
_________________________________________________ Code Enforcement Officer, Town of Tusten
Dated:___________________________________________
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