App-Permit ( r
--43,L oTz- Z) -bo5(i)C., ZDK"a mg 110 0,
2,
N. 2_1 • �lX i 'C 4
FEE \\O
2I,os1-{ COMMONWEALTH OF MASSACHUSETTS
Board of Health, Yarmouth,MA
APPLICATION F0I1 DISPOSAL SYSTEMI CONSTRUCTION PE ',MIT
Application for a Permit to Construct()Repair()Upgrade()Abandon()-❑Complete System❑Individual Components
Location 4a�tl Aei-c,1.6, Owner's Name a,(,_1 ,
Map/Parcel# 93 / 9 - J Address 4a S7-es-Qm‘e___,
Lot# / ' Telephone# 774— 90 L 6E07
Installer's Name CQ ve Designer's Name eDlit \ l i_- CJ INT,12eXi e_
Address g V\� 1a,,rQ_ t'1�,uv_- Address � /U,•N CNS[cse.e `YaryUPYYAriA '`."t\(
Telephone# VrO /0— ,7��g fl Telephone# /q!k-- pia- y m
Type of Building ANYIei _Lot Size 41,547 sq.ft.
Dwelling—No.of Bedrooms LI Garbage grinder( )
Other—Type of Building \-\pYvxQ_, No.of persons Showers(),Cafeteria()
Other Fixtures
Design Flow(min.re uired 9 O gpd Calculated design flow y,Ss- Design flow r vide U/.S gpd
Plan: Date 12 Fl�afj Number of sheets I Revision Date 1 )3Q 06
Title
Description of Soil(s)
Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS See, Tkr
.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 to place the system in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed , �� Date,V02a/
Inspections
NoaMM 2A'2-L Z O I V
1 I \ ‘0
COMMONWEALTH OF MASSACHUSETTS Nee = C
,,t6
Board of Health, Yarmouth,MA I 156J-4
DISPOSAL SYSTEM CONSTRUCTION PERMIT --a---:-"%gt4 Orr
Permissionis here g anted to• C nstruct;�Q Repair() Upgrade Abandon
yi O O an individual sewage disposal system at
Disposal System onstruction Permit No.2 I— Oc& , dated 3/2-Z 2.0 24
as described in the application for
/
Prov�ild : onstruction shall be completed withi thr yrd the date of this permit.All local conditions must be met.
Date 7 b I Board of Healtk