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HomeMy WebLinkAboutUnit R - 2020 Feb 18 - Sign Off Transmittal, Plans - Natty's Nail Spa oc. ,4ky TOWN OF YARMOUTH HEALTH DEPARTMENT PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To he completed by Applicant: ZDUT CA t Building Site Location: c\2 -3 ;C=Y�fibe rrj )- uj unik �c..livivoi i� Pot+ Proposed Improvement: No.; 1 5 PA .i cif' °".' W Velt . I .t ✓-Q. s cc.. G h ..i. = c1 ,' 1 Applicant: g.t,r e. V>ohtlici Tel. o?; 508641 b19 2 0 1 Address: ‘7 Pkl k'-: ) 1 j c j I\ , `? i ) ( A�1 C ) Date`, i led: ? � (`�'?4) **lfyou would like e-mail rnog/Ica:ion ofsign off please provide e-mail address: Owner Name: 5-.....1 if cA.w e✓' f'1cwl kis /, LAt Owner Address: &Y as 6 � ��'�' Owner Tel. Na.: w RESIDITIAL AND/OR COMMERCIAL BUILDING I HEALTH.DEPARTMENT: Determines Compliance-to State and Town Regulations;i.e., Requirements 1 For Septage Disposal and other Public Health Activities. 1 Please submit three (3) copies of plans, to include: (1.) Site Plan showing existing buildings,water line location, and septic system location; (2.) Floor plan labeling ALL rooms within building (all existing and proposed),— Note:Floor plans not required for decks,sheds, windows, roofing; (3.) If necessary, Title 5 application signed by licensed installer with fee. REVIEWED BY: / ' DATE: 44116/01C:51° 1 PLEASE NOTE COMMENTS/CONDITIONS: . .off YARD TOWN OF YARMOUTH BUILDING DEPARTMENT S{: APPLICATION FOR DETERMINATION OF NON-APPLICABILITY )c 04 . �� �s AQUIFER PROTECTION BYLAW §406.5.1.1 • Applican/Business Name: I\ a+ j 'S N al 1 S PA Date: ©2 ' f 0 / 2 o 2.o _J Property Owner: Click pie 1( Iwo L I C Property location: e\Q C rc�n �d � I4 w l Unit# Map&Lot# Proposed Use: No:,\ S PA 1. 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. OQ be/2070 A !cant Date Print Name DETERMINATION: The Building Inspector, based upon a review of this application and information supplied by the Applicant,hereby determines that the proposed use satisfies the requirements of§406.5.1.1 and that the Applicant need not apply for a Special Permit under§4 A/6/01-°,040. Building Inspector Date Health Agent Date Form must be tiled 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 FROM: Yarmouth Health Department SUBJECT: Hazardous Materials As part of the application process for a Board of Appeals bearing or Determination of Non-Applicability, please complete this form and return it with your application. For tiuther information con materials regulations,contact the Health Department Office. In 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 quantitle& Antifreeze,Engine&Radiator Flushes Motor Oil Hydraulic, Brake,Automatic Trans. Fluid Gasoline/Fuels Grease,Lubricants Degreaser/Cleaners Floor/Driveway Degreaser Battery Acid Rustproofing/Undercoating Vehicle Detergents Vehicle Waxes,Polishes Asphalt, Tar, Sealers Paint, Varnishes, Stains,Dyes, Thinners - Wood Preservatives Dry Cleaning Solvents,Carbon Tetrachloride Floor/Furniture Strippers Other 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 SludgesOth (List) x !�ce\oto. •- ratcbhoi Applicant Signature: Date: n2//eholo HEALTAPDDETER 10-99 —.it/w __._ _ „,ata • 1 ' i , I 'h -Lig .tS nI I. 4:::: ID I #` v r. r,--1,-1::::.7:,!-1-'-z----',''.., ''..\''..)---.is' c\it(”) : N liii t „ ,jrrr jttt cx) fix= I hi e i r I 1 q- • Z i, j 1 S ti� Fj Qt ri.,1 Iii C �� I i Ci qaY ). 1 I 1 i' I I 3 }} E , ;,,,,,- 1; { ({ �� t�? � �i I E I t f;`---`alt ,/ 4, Ill 1 m -41 1 ._L. _.._. v) Z..' j i A, D � (J)Jw '-',----,17:::::,::::: ,w rv.._. sem- i 5 1 I 8 . 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