HomeMy WebLinkAboutApp-Permit OV'T ZDNE - -
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COMMONWEALTH OF MASSACHUSETTS
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct()Repair Upgrade Abandon()- r Complete System r Individual Components
Location 5 ( /vie /V,`/,e ?d Owner's Name ji€' 't'CoRe/ ReisTv
Map/Parcel# 1944.1Ci" /1,9,j
/3,1 Le 12/3d/diA Address e/I'fe/44 i/
Lot# 46,7 Telephone#
Installer's Name r/ eloefl't.K Designer's Name "rid R.A,c,
Address i 1/ 4///#00/,c ' -Kcif S?tic.'/f Address hIy,'4./et�t
Telephone# rd/ VO q 1---F-7a. Telephone# re,r y',ld I Fit
Type of Building A,P r _Lot Size /,) �� f sq.ft.
!
Dwelling-No.of Bedrooms_ Tl./.....)C) �C� Garbage grinder( )
Other-Type of Building No.of persons _ Showers(),Cafeteria ()
Other Fixtures
Design Flow(min.required) ei gpd Calculated design flow "-I Q_ Design flow provided 7 y8 gpd
Plan: Date 1/C? /XO Number of sheets _ Revision Date
Title Ti4--tei "STK/ .- Coe/ 4 orr 6
Description of Soil(s)
Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS
.The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees to not toopplaacce the system in operation until a Certificate of Compliance has been issued by the 3oard.of Ii -- -_7---)Signed `r _ /ilk Q
��/t /� Date er/ /.
AUG 2020
Inspections
-IEALTH DEPT.
No • OkIC;VAFEE
COMMONWEALTH OF MASSACHUSETTS Neuf
Board of Health, Yarmouth, MA S P✓UJ
DISPOSAL SYSTEM CONSTRUCTION PERMI
7Per fission is her y granted to: Construct () Repair () 1] -1.-- de ) Abandon () an individual sewage disposal system at
44 ►1 _.1 4."C Cr< /Ari//t as described in the application for
Disposal System Construction Permit No. 2-0 — 1'( , dated S/ 1 3 00 2Q
Provided: Cons ction shall be complete. within thr:, years date of this permit. All local conditions must be met.
Date j oard of Health / elk `d,600 /