064
.
Received by:
Chris Masterson 0
Christine Fulton 0
Sue Rose '%'
12 / .J3/ .iJL
Jli-
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
Date Received:
FOIL Ser. #:
DEPARTMENT:
ASSESSOR IZI
ACCOUNTING 0
CODE ENFORCEMENT ~
PLANNING ~
ZONING ~
FIRE INSPECTOR ~
ffiGHWAY 0
RECEIVER OF TAXES 0
RECREATION 0
SUPERVISOR 0
TOWN CLERK 0
WATE~SEWER ~
DOG CONTROL OFFICER 0
TOWN ENGINEER ~
TOWN ATTORNEY 0
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
/ /
(in it)
Date Applicant Contacted:
/
/
I /
/
Notes:
Amount Due:
Pages for a total of $
Name: Robert McCarthy
Address: 54 Tuttle Place
Middletown. CT 06457
Agency or firm: VHB
Telephone#: (860)632- -1500
Email address: rpmr.r.Flrthy(1i)vhb r.nm
o check here if you are
requesting that the records
be mailed to this address.
FAX #: ( 860) ~- 7879
SPECIFIC DESCRIPTION OF RECOJU):
We are comp~etlng an envlronmental assessment for the property:
1324 Route 9 (southeast corner of Old Hopewell Road)
and request any historic records related to Site use, ownership,
Occupancy. hazardous material storage or handling. and sewer and
water system connection details.
FORMAT OF RECORD (if available)
IZI I request to be notified when I can come to inspect the record(s) described above
o 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
o I request that the records be faxed to the number listed above