HomeMy WebLinkAboutApp-Permit No.fl-.� 1i az (0 FEE )
�,CJ COMMONWEALTH OF MASSACHUSETTS s«-(- SL- 'n L-
2 2 - C)Co ( Board of Health, Yarmouth, MA TA-4-Dt--
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct()Repair Upgrade()Abandon()-0 Complete System 0 Individual Components
Location 5 ,Q 2.4.0boc.K s'i--: Owner's Name VA/tiltS /L1Agj/N!
Map/Parcel# .3 V/ 2 D/ Address (shim J
Lot# Telephone# l
Installer's Name/266,„_r a Our LQ . Designer's Name
Address 3‘. LauL eikii.t S . yt724001 Address
Telephone# St "1- ? — 8 g 7 7 Telephone#
Type of Building _Lot Size sq.ft.
Dwelling—No. of Bedrooms Garbage grinder( )
Other—Type of Building No.ofersons Showers
p (), Cafeteria()
Other Fixtures
Design Flow(min.required) gpd Calculated design flow Design flow provided gpd
Plan: Date Number of sheets Revision Date
Title
Description of Soil(s)
Soil EvaluatorForm No. Name of Soil Evaluator Date of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS ] ?%T1 COrc Lb S rr'fccC ('� StAi F k-
W .' 45 A174.4:—. j to 4- A.,.c n (t my c a-1-t4.a 2q hrs. /a Cl'+r IF CO ?I M
.The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees to no, o place the system in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed � ._ Date 3 "z -2Z- RECEIVED
Inspections MAR 29 2022
HEALTH D EPT.
No. �-. l FEE i5
o Z L J
COMMONWEALTH OF MASSACHUSETTS 56-#4-c s6—p--/-7 e_
Board of Health, Yarmouth, MA Tu<L
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct() Repair KUpgrade() Abandon() an individual sewage disposal system at
S gri-+k-ib'Dac4- s- -- as described in the application for
Disposal System Construction Permit No. Z2- 4.4.1 , dated !/Z' /zc Z -
•
Provided: Construction shall be completed within ttttroZt5of the date of this permit. All local conditions must be met.
Date 3/24/Zo a- Board of Health -s