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V�No. 2- (ccr'-f-)- FEE
':3 -21- oovq`'1 COMMONWEALTH OF MASSACHUSETTS 3 9 3
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct repair()Upgrade( )Abandon()-[/Complete System D Individual Components
Location GAG 1 ).n (X . Owner's Name I,I-ICklp h nQ icA
Map/Parcel# Ades 71 i_ C5SS 10() (0
Lot# a Telep`Cione P k`�Jk
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Installer's Name CC C1. c'N Designer's Name • / ex c
Address k
ch --. ,=_'1 k r A� ' , Address "� `�p` V i Il...d. �. ,nnt�t,eA
Telephone# 1-74-4a �CA Li Telephone JJZSNS C)kCt
Type of BuildingNDo . (;- -'I,otSize_al (;- -' _sq.ft.
Dwelling—No.of Bedrooms `�Q,� ( Garbage grinder( 1
Other—Type of Building No. of persons Showers( Cafeteria()
Other Fixtures
Design Flow(min.required ISM) gpd Calculated design flow Design flowprpv1id� 9 gpd
Plan:DON),
e� Nu er of sheets 1,� 1 Revision ate IJJ p� ` j"�1
Title lJ • SP C 1-0( ( ) �> G'o
Description of Soil(s)�F��� San t
Soil Evaluator Form No. Name of Soil Evaluator lit: , 1.4._ Date of Evaluation l f% (6 '
DESCRIPTION OF REPAIRS OR ALTERATIONS
New ,,
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Q S00 . • ' cu�Ql›r ^ €
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.The undersi' .ed agrees to install the a/,ove described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agr:' to not to place the sys m in operation until a Certificate of Compliance has been issued by the Board of Health.
Signe of _ _ Date 7/1 o( -o
Insp.ctions
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NOBCPMC-i0 01(aD C2'2_- c't ) FEE I 1
COMMONWEALTH OF MASSACHUSETTS
Board of Health. Yarmouth, MA
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted
�te_dd to; _Cogstruct fk Repair() ()Upgrade Abandon() an individual sewage disposal system at
Z le ill (� as described in the application for
Disposal SystemConstruction Permit No. 2.0—BIZ , dated .411/2D .
Provided: Construction shall be completed within three years of the date of this permit. All local conditions must be met.
Date Board of Health