HomeMy WebLinkAboutBHDC-05-149No. 09 _141 �j% d 1 4i [ib
FEE
COMMONWEALT14 OF MASSACHUSETTS
YARMOUTH HEALTH DEFT.
Board of Health]
APPLICATION FOP, UISPMAVM ' `�I OMRUCTION PERMIT
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( O Complete System O Individual Components
Location
Owner's Name
Map, Parcel# .- r
Address 1-? t
Lot#
Telephone#
Installer's Name 15GOn
Designer's Name Dosrw
Address .0 bo)( (P GADJ6114,
Address (01 Rg f 1
Telephone# Q,?�) S —33a6
Telephone# Ci
Type of Building.
Dwelling - No. of Bedrooms L�
Other - Type of Building
Other Fixtures I
Design Flow (min. required) 4qD gpd Calculated design flow
Plan: Date Number of sheets
Title
Description ofSoil (s)
Soil Evaluator Form No. Name of Soil Evaluator
DESCRIPTION OF REPAIRS OR ALTERATIONS
6,01Dh i -Pal
Lot Size sq. ft.
Garbage grinder( )
No. of persons Showers ( ), Cafeteria ( )
Design flow providedigpd
Rc%ision Date
Date of Evaluation
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
-further t t p tem in operation until a Certificate of CompliT
ce has been issued by the Board of Health.
. Signed _ Date
Inspections
t
Z� S -� iWc/!�f .t /�at6o�%
No. ri- =►. ` ''�• . p C�{ 7 { Da� FEE
C®NINI®NWEALT14"ASSACHUSI:TTS
Board of Health, MA.
APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon(} J Complete System ❑ Individual Components
11 Location
Map/Parcel# (,0�0-42a
Lot#
Installer's Name D, r I ) Last}
Address ?,o
Telen� C_- rYiC �rz
Type of Building
Dwelling - No. of Bedrooms
Other -Type of Building _
Owner's Name
Address A- W Q�
Telephone#
Designer's Name DQv-r-4w
Address ,0, paip_K 54{
Telephone#1
Other Fixtures
Design Flow (rain, required) _ ;' gpd Calculated design flow
Plan: Date Number of sheets
1• {
Title
Description ofSoil(s) _
Soil Evaluator Form No.
DESCRIPTION OF REPAIRS ORALTERATIONS
- i "), -/,oc� GrxttnV1 `s>n
Name of Soil Evaluator
No. of persons
Lot Size sq. ft.
Garbage grinder ( )
_ Showers ( ), Cafeteria ( )
Design flow proiRded t �' fgpd
Recision Date
Date of Evaluation
,t,t
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further - tit pla tem in operation until a Certificate of Complia ce has been issued by the Board of Health.
•_Signed Date _ `J
i
d lispections
r
No. 7 7
COMMONWFALT14 Of MASSACHUSETTS
Board of Health, /lam rye,/,& &!I MA.
CERTIFICATE OF COMPLIANCE
Description of Work: ;3Udividual Component(s)
The Undersigned hereby certify that the Sewage Di!
by:\�i �.��'
at Itio F' i /1C p t 1:
0 Complete System
System; Constructed ( ), Repaired ()0, Upgraded ( ), Abandoned ( )
has been installed in accor $ce with the provisions of 310 CMR 15.00 (Title 5) androved design plans/as-built plans relating to
yp
application No.L�%S-/ date S - / 7 D Approved Design Flow 47 (gpd)
Installer _ Q11 1, 0 ( 9
Designer- t f �l� Q,� Inspector: - 1' r Iv Date: _ G
The issuance of this permit shall not be construed as a guaranke that the system will function as designed.
No. _ �CLY� FEE
lU.
C®MM®NWF-ALTN Of MASSACHUSETTS
Board of Health, MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is here�ibyygranted to; Construct( ) Repair(A Upgrade( ) Abandon( ) an indi«dual sewage disposal system
at Q L�}{'1' ITTQ Y • �QC,I� W r �Q r`yy( } -! n�4A as described in the application for
Disposal System Construction Permit No. _ t �L, dated
Provided: Construction shall be completed within tla=�—rs of the date of this permit. All local conditions must be met.
Form 1255 Rev. 5 96 AM Sulkin Co. Boston, MA Date Board of Health
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TO ALL NEW BUSINESS OWNERS
DATE: �)q jaz IVY riFill in please:
APPLICANT'S
BUSINESS
YOUR NAME: Zt sgg 1 o LopES
YOUR HOME ADDRESS:_ 11 �6 _ D� /�/2 J
"A o2�73
TELEPHONE Telephone Number (Home) S�J S
NAME OF NEW BUSINESSN)yg cL.)C A� ,Yl i Nr� tap ► , _,zetv;cr� TYPE OF BUSINESS_
IS THIS A HOME OCCUPATION? YES LLJ N
Have you been given approval from the building division? YE INO
ADDRESS OF BUSINESS 0 vJk-i rT-\ MAP/PARCEL NUM
���( (COP)
i IJ t NEB 9-1 eLJZ_ a N, r3
When starting a new business there are several things you must do in order to be incompliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you In obtaining the information you may need. Once you have obtained the required signatures,
listed below, you may apply for a business certificate at the Town Clerk's Office (Ist floor - Town Hall) or if you get the business certificate first
you MUST go to the following office to make sure you have all the required permits and licenses..
GO TO 200 Main St. — (corner of Yarmouth Rd.'& Main Street) and you will find the following offices:
1. BUILDING COMMISSIONER'S OFFICE
This individual has been Informed of any permit requirements that pertain to this type of business.
Authorized Signature"
COMMENTS:
2. BOARD OF HEALTH
This individual has been informed of the permit requirements that pertain to this type of business.
Authorized Signature"
COMMENTS:
3. CONSUMER AFFAIRS (LICENSING AUTHORITY)
This individual has been informed of the licensing requirements that pertain to this type of business.
Authorized Signature"
COMMENTS:
Business certificates (cost $30.00 for 4 years), A business certificate ONLY REGISTERS YOUR NAME In the town (which you must
do by M.G.L. - it does not give you permission to operate - you must get that through completion of the processes from the various
departments Involved.
"SIGNIFIES APPROVAL FOR A BUSINESS CERTIFICATE ONLY.
SCANNELP
CHECK OR FILL IN WHERE "P.LICABLE
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