Doh 5025 Form PDF Details

Created in 2004, the Doh 5025 Form is a document used to request an exemption from the Unified School District of Philadelphia's mandatory residency requirement. The form must be completed and submitted by the parent or guardian of a non-resident student who wishes to enroll their child in a public school within the district. In order to qualify for an exemption, the student must meet one of the following conditions: be homeless, have been placed in foster care, or have been transferred to Philadelphia as part of a court-ordered case involving abuse or neglect. For more information on the Doh 5025 Form or other enrollment requirements for non-resident students in Philadelphia schools, please contact the district's Office of Enrollment Management.

QuestionAnswer
Form NameDoh 5025 Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesny completion sample, nysdoh bwsp, doh 3735 form 2019, doh 5025 pdf

Form Preview Example

New York State DepartmeNt of HealtH Bureau of water Supply protection

Engineer’s Certification of Public Water Improvement Project Completion

New York State Department of Health Bureau of Water Supply Protection (NYSDOH BWSP)

Application for an Approval of Completed Works

1. public water System Name:

 

 

 

 

 

2. pwSID Number:

 

3. project location

 

 

(City, town, Village)

 

 

 

 

 

County

 

4. Drinking water State revolving fund (DwSrf) project:

Yes

No

If Yes, DwSrf project Number:

 

 

 

 

 

 

 

 

 

 

 

 

5. plans approved by NYSDoH BwSp:

Yes

No

If Yes, NYSDoH BwSp project log Number:

 

 

 

 

plans approved by : (check all that apply)

 

 

 

 

 

 

 

 

 

 

 

NYSDoH regional office

NYSDoH District office

County Health Department

6. Construction Start Date:

 

 

 

7. Substantial Construction Completion Date:

 

 

 

 

 

 

 

 

 

 

 

 

(provide a copy of the notice to proceed with this application)

8. project Description:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9.pursuant to the NYS Sanitary Code part 5, Subpart 5-1, Section 5-1.22 I hereby request that an approval of Completed works be issued for the above referenced project. By affixing my seal and signature to this document I certify that the construction of the referenced project including any required environmental mitigating measures was substantially completed in accordance with the approved plans and specifications or approved amendments thereto. In addition,

a set of the final “as-Built” record drawings and operation and equipment manuals, have been, or will be, provided to the project owner.

10.Deviations from approved plans:

(attach separate sheets if additional space is needed)

11. engineering firm:

(Name of firm)

(print Contact person Name)

 

(phone Number)

NYSEngineersSealandSignature

Date Signed:

If the box for he NYSDOH BWSP is checked Yes in item 5:

Send completed form to: NYSDoH BwSp empire State plaza Corning tower, room 1168 albany, NY 12237

or e-mail to: bpwsp@health.state.ny.us

If the box for he NYSDOH BWSP is not checked Yes in item 5, then send the completed form to the appropriate Regional office, District office or the County Health Department that approved the plans.

DoH-5025 (11/12)

How to Edit Doh 5025 Form Online for Free

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Step 1: First of all, access the pdf editor by pressing the "Get Form Button" at the top of this webpage.

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With regards to the blanks of this particular PDF, this is what you need to know:

1. First, once filling out the ny completion, start with the form section with the next blanks:

nysdoh completed sample writing process explained (part 1)

2. The third step is to complete these blank fields: project By affixing my seal and, Deviations from approved plans, engineering firm, Name of firm, attach separate sheets if, phone Number, print Contact person Name, Date Signed, NYS Engineers Seal and Signature, If the box for he NYSDOH BWSP is, Send completed form to, NYSDoH BwSp empire State plaza, or email to, bpwsphealthstatenyus, and If the box for he NYSDOH BWSP is.

If the box for he NYSDOH BWSP is, Deviations from approved plans, and Name of firm of nysdoh completed sample

Be extremely attentive while filling in If the box for he NYSDOH BWSP is and Deviations from approved plans, since this is where a lot of people make errors.

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