HomeMy WebLinkAboutApp-Permit iawere-21-002$Ci-r)
No. ip,i`./_. - 2-o -5 FEE "V
20 -1 115 COMMONWEALTH OF MASSACHUSETTS
Boardof Health. Yarmouth,MA
APPLICATION FOR DISPOSAL SYSTEM C9NSTRUCTION PERMIT
Application for a Permit I Repair I I Upgrade t i Abandon I } eaapktoe System 0oo[ Component!'
Camaent
Location if l L r c-e,_ 5-r Owaer`a Name it- .'`/dl.,/tolp C..
Map,Parcel A Address �
Lot d 1 Telephone N
Installer's Flame^M-G`_,A_2..e. Ei,� ) 1 Designer's Name
Address 51� IYJLJ�SL"1 r,,p.x.y,e Address
ed 1 35 3 . LIQ 2% I Telephone ti
Type of Building /4-4/.4.,#) _LotSize I(;,Q ' sq.R.
Dwelling-No.of Bedrooms �_--- Garbage grinder t I
Other-Type of Building No.of persons Showers t),Cafeteria()
Other Fixtures *�(_
Design Flow train.re ui l- C)gpd Calculated design flow 1) Design flow provided 3 6.
--gpd
Plan: Date 71 if Z4 Number of sheets _ Recision Date�,
Title ,/� a B /� ,-
Description of Sails) /(!_.4/r(M- - Q F /� it tQ.�Cp ,erc._r""Ek- 1"41.
Soil EvaluatorFoun No._ /C' I Name of Soil Evaluator ![J f i 1 (�_Date of Evaluation— 1/3 Q, 20
DESCRIPTION OF REPAIRS OR ALTERATIONS //7 er y./f P!•e-Ing/ f.slop/C-c-- S 1 d A«`
The undersigned agrees to install the alto a described lochs idual lien age Disposal Ss stem in accordance wNh the proslsioas or TITLE.S and
further agrees toaid totoplace the sss�teern in operation until a Certificate of Compliance has been issued by the Hoard of Health.
Signed __\_o it. tee(/ + pith: 7(( 1 CO
inspections __.......
No. 0 'l "Z0 ' 0 2S
1� ME t v V
COMMONWEALTH OF MASSACHUSETTS N l e4e s, -V�K„/
Board of Health. Yarmouth.MA I . Q�-- Int r 1 4
DISPOSAL SYSTEM CONSTRUCTION PERMIT 2- kali ,
PermissIn is hereby granted tot Construct t) Repair C ) Upgrade t I Abandon( 1 an individual sewage disposal system at
'(ER C- ST ') u described in the application for
Disposal System Construction Permit No. -Q—I US ,dated I till t 'LJ
Provl •Co ruction shall be completed within t-I etyearsthe ate of thi3 permit_All local conditions must be met.
die
�1 n /�
Date 11 (� Zo Board nr Heat /I. .iL• ��/'
110
JUL 21 2020
HEALTH DEPT.
haps://mail.klinehouselifting.com:2096/cpsess6320862800/3rd...=1&_mbox=INBOX&_aid=17631&_part=3&_action=get&_extwin=l 7/14/20, 9:44
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