DATE: TO: Westchester County Department of Health Bureau of Environmental Quality Mount Kisco Field Office 118 North Bedford Road Mount Kisco, NY 10549 Re: Property of Located at Section Block Lot Gentlemen: This letter is to authorize_______________________________ a duly licensed professional engineer/registered architect to apply for a Construction Permit for a separate sewage system; private water supply; to serve the above-noted property in accordance with the standards, rules or regulations as promulgated by the Commissioner of the Westchester County Department of Health, and to sign all necessary papers on my behalf in connection with the matter and to supervise the construction of said system or systems in conformity with the provisions of Article 145 or 147 of the State Education Law, the Public Health Law, and the Westchester County Sanitary Code. Very truly yours, Signed ______________________________ (Owner of Property) ______________________________ (Print Name) Countersigned: _____________________, P.E., R.A.#_____ ______________________________ (Address) _____________________ (Seal) ______________________________ (Address) (Telephone) ___________________________________ ___________________________________