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WORK SMI►LL NOT PROC ED •„In--,°� r.a /
'-
UNTIL THE INSPECTOR HAS * —UCTION ".: ` #' r.! ffi . "
APPROVED THE VARIOUS MONTHS OF DATE*", — ft " � %
STAGES OF CONSTRUCTION +> +,-4 ^^ �r ` "3
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A
•'. TOWN OF YARMOUTH BUILDING DEPARTMENT
r 43' 44p APPLICATION FOR DETERMINATION OF NON-APPLICABILITY
4 g e
f1 `°r � �� �1� AQUIFER PROTECTION BYLAW §406.5.1 1
%Applicant/Business Name$ ve a I6/ (V5/vY1 ZLC Date: 7//o///
Property Owner: ,C44 /• 1q 4'4,-/
�O it Map&Lot#
location: t'N, 1 /, GG9 /eh//e/n' �i Lot#
a� 1
Proposed Use:Skrh�e 74a�.5 / AL'AP/n"A/ , 11 I ic7/,lac/1&it
/
I. Has applicant has fully complied with the Submittal Requirements of§406.5.2 ?
(Attach copy of Hazardous Materials List)
2. Does the proposed use meet all of the Design and Operation requirements of§406.5.7,
3. Are the chemicals,pesticides, fuels and other potentially toxic or hazardous materials used or
stored at the site,or produced by the proposed use, in qualities not greater than those
commonly associated with normal household use,
4. Does the proposed use meet all of the objectives and water quality criteria of the bylaw:
The above applicant hereby acknowledges that the Building Inspector may require the applicant to submit the
matter to the Health Agent or Board of Health,and may require the applicant to demonstrate that he/she has
received a favorable report from the Health Agent or Board of Health. The Determination,if made,shall apply
only to the individual applicant and proposed use and shall automatically expire upon any change of use or
transfer of ownership of the business. There shall be no appeal from an unfavorable Determination of any such
application,nor from a failure to act,except for filing by the applicant for a Special Permit from the Board of
Appeals as otherwise provided herein. (-(1- (U.ff
7A4 9ApplicDate
61a1A07 /g. tlita r/JA) '7-g
Print Name
DETERMINATION: - B ' . _ Inspector, based upon a review of this application and information
• •pl • by the •• •: . •• , ere• `• termines that the proposed use satisfies the requirements of§406.5.1.1 and
that t e Appli.. ,_ " not • �, for a Special Permit under§406.5t� %r ' - COAPE0e0404, I
Buildi 'Z,�r!S`. Date Health Agent A
Date
Form must be Bled with the Town Clerk and copies of this form must be sent to the following
departments(as listed in§406.5.4);Water,Engineering,Fire,Health,Planning,Conservation,Board of
Appeals.
Aquifer Protection District Waiver 05/08
TO: Commercial Applicants in the APD
tt •
FROM: Yarmouth Health Department
SUBJECT: Hazardous Materials
As past of the application process for a Board of Appeals hearing or Determination of Non-Applicability,
please complete this farm and return it with your application. For timber information concerning hazardous
materials regulations,contact the Health Department Office.
In the conduct of your present and/or proposed business, do you store, use, generate any of the
following types of products? Please check all which apply and list quantldes.
Antifreeze, Engine& Radiator Flushes q ) k Motor Oil n
Hydraulic, Brake,Automatic Trans. Fluid Gasoline/Fuels
Grease,Lubricants Degreaser/Cleaners
Floor/Driveway Degreaser Battery Acid
Rustprooing/Undercoating Vehicle Detergents
Vehicle Waxes,Polisher Asphalt, Tar, Sealers
Paint, Varnishes, Stains,Dyes,Thinners Wood Preservatives
Dry Cleaning Solvents,Carbon Tetrachloride Floor/Furmiture Strippers
Otter Cleaning Solvents Rock salt,Road salt
Drain,Toilet,Cesspool Cleaners Refrigerants
Bug&Tar Removers Photo chemicals
Printing Inks&Dyes Pool Chlorine
Pesticides, Insecticides,Herbicides Rodenticide,Fungicides
Nitrate Fertilizer Jewelry Cleaner
Leather Dyes PCB=s
Electroplating SludgesOthers )
Applicant Signature: . (JO Date:
—7//00
HEAL TAPDDETER I 0-99