HomeMy WebLinkAboutApp-Permit-ComplianceNo. FEE Ao. 47
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THE COMMONWEALTH OFMASSACHUSETTS
(. (# /
MASSACHUSETTS Y
�platiration for Cgonstr rtion Ilermit
Application is hereby made for a Permit to Construct (� or Repair ( ) an On-site Sewage Disposal System at:
Location Address or Lot No.�g¢
ion , ,� •� �,�- C-77
Owner's Name, Address and Tel. No.
D �•
Insta®ller's Name, Addr-7es-s, and Teel.No. jr —�$
Designer's Name, Addres and Tel. No.
G 'f l
430"-/ f60� Jr 7710
Type of Building:
Dwelling No. of Bedrooms Garbage Grinder ( )
Other Type of Building No. per Persons Showers ( ) Cafeteria ( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow 42 � gallons.
Plan Date '� 3 g� Number of sheets Revision Date
Title
Nature of Repairs or Alterations (Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the aforedescribed on-site sewage disposal
system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a
Certificate of Compliance has been issued by this Board of Health.
Signed Date
Application Approved by Date
Application Disapproved for the following reasons
Permit No.
7(O "� Date Issued
THE`/C'OMMONWEALTH OF MASSACHUSETTS
Yfh2.�lr�/?9� MASSACHUSETTS &1
Cez#tftrate of (gontylinure � m
THIS IS TO CERTIFY, that the On-site Sewage Disposal System installed or repaired ,replaced ( ) on
6 7-- '76—b _' for / - 0;0"moi f}
at /�� �L/1� �� ��� as been constructed in
accordance with the ovisions of Title 5 and the for Disposal System Construction- ermit No. �-�3 dated
S' Use of this system is conditioned on compliance with the provisions set forth below:
The issuance of this certificate shall not be cpnstrued as a guarantee that the system will function as designed. This
Certificate expires on t
.DATE 6 �% �� � Inspector
t
_ No. Fee _
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
2pplicatiou for �Dtgogal *pgtem Corvgtructtou Permit
Application is hereby made for a Permit to Construct (X ) or Repair ( ) an On-site Sewage Disposal System at:
Location Address or Lot No.
Owner's Name, Address and Tel. No.
16 Z W H 11C L6GK„ F,b
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P,,� c,,�l-o-
s . A EMdvf 10
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5r7 L92
Installer's Name, Addre s, and Tel. No. ?��� —is b'�
`psj�� J`�-M
Designer's Name, Address and Tel No.
Eh4l�/Nt✓EruJ�tG-
#�� 1 �t -� -7 +"F'�
I
F3o�0 443
W, DeNN L5 39$-l7 t b
Type of Building:
Dwelling No. of Bedrooms
Other Type of Building
Other Fixtures
Design Flow 530
Plan Date
Title SIT
Description of Soil U -
-q_ 9.c
Garbage Grinder ( )
No. of Persons
Showers ( ) Cafeteria( )
gallons per day. Calculated daily flow ?So gallons.
Number of sheets 01 -le. Revision Date
i All-,
- 3z M
17th M
Nature of Repairs or Alterations (Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ure the onstruct'
in accordance with the provisi s o Title of n
cate of Compliance has been i ued is of
Signed
Application Approved by
Application Disapproved for the following reasons _
Permit No.
and maintenance of the afore described on-site sewage disposal system
mmental Code and not to place the system in operation until a C rtiii-
_ Date
it WZ9 41
Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE,. MASSACHUSETTS
(,Certificate of Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System installed ( ) or repaired/replaced ( ) on
by for
as has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. dated
Use of this system is conditioned on compliance with the provisions set forth below:
No,
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
Migpogar *pgtem Cougtruction Permit
Permission is hereby granted to
to construct ( ) repair ( ) an On-site Sewage System located at
Fee
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
All construction must be completed within two years of the date below.
Date: Approved by