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Forms Can Be Submitted via Email to lodclI11,'cDtowjjof-,v -y-go orinpersoi-L/viaiiiailto2OMiddlebush
Rd Wappingers Falls, NY 12590
FOR INTERNAL USE ONLY
Received by: Joseph P. Paoloni 1 -
Lynn O'Dell
Lori McConologue F,
Date Received: / /
FOIL Ser. #: rC)
DEPARTMENT:
ASSESSOR
ACCOUNTING
CODE ENFORCEMENT
F%?e
PLANNING
11
ZONING
El
FIRE INSPECTOR
HIGHWAY
RECEIVER OF TAXES
L1
RECREATION
0
SUPERVISOR
Ll
TOWN CLERK
R
WATER/SEWER
D
DOG CONTROL OFFICER
0
TOWN ENGINEER
Cl
TOWN ATTORNEY
U
EF" r
r
J AN0 6 2:1'
BuHd�ng Depaarn! ent
Town of Wappunger
FOR DEPARTMENT TMF MT T TQ F7 n -NT LY
Date Received by Dept
Department I -lead approval
Date Applicant Contacted:
Date FOIL fulfilled or denied:
Closed by:
Date: j / -7
Notes: A
tI
Amount Due: — Pages for a total of $
Name:
jaume A I ._ I GWlvon
Address, i32_
Agency or firm:_ IC.e uart)w-% Unite
Telephone #: 3q I -3C161 FAX #:
Email address: C_
e M b r , L[<�W, C o Y1,1
SPECIFIC DESCRIPTION OF RECORD:
X-cheekhere if you are
requesting that the records
be mailed to this address.,
FORMAT OF RECORD (if available)
I request to be notified when I can come to inspect the record(s) described above
L I request copies of the records described above and agree to pay the cost of such records in
accordance with the fee schedule on the back of this application
I request that the records be sent via e-mail to the address listed above
F I request that the records be faxed to the number, listed above