HomeMy WebLinkAboutBLDC-25-144 APD .47
BLDC- Z5 /44
TOWN 01:NARMOI 'ill 111 11.l)IN/: DEPARTMENT
,7' (3 APPLICATION FOR 1)1. I LUMINA!lINAI ION Ol NON-AI'PLI ABll,l'I'Y
o _ "
po r!..1; AQUIFER PROTECTION ION IBYI,AW §406.5.1.1
ApplicantlBusinessName. /1/)Q//1//C Cr/c710/7j '1jJ//Ors' Date: /Si /5 ia2r
Property Owner:
Property Location: .2O(2 ,(/ Ye-c dfik, Unit /3 Map&Lot
u/�5t y,�rmo
Proposed Use. c/S O/✓ CAW YA'S (0,70/ y21D4-747 7 ,efpic/77//'0YJ
1. Has applicant fully complied with the Submittal Requirements of§406.5.1.1?
(Attach copy of Hazardous Materials List)
2. Are the chemicals, pesticides,fuels and other potentially toxic of hazardous materials used or stored at the
site. or produced by the proposed use, in qualities not greater than those commonly associated with normal
household use? Yes No V
3. Does the proposed use meet all of the objectives and water quality criteria of the bylaw? re
The above applicant hereby acknowledges that the Building Commissioner may require the applicant to submit the matter
to the Health Agent of Board of Health and may require the applicant to demonstrate that he/she has received a favorable
report from the Health Agent or Board of Health. The Determination, if made,shall apply only to the individual applicant
and proposed use and shall automatically expire upon any change of use or transfer of owne ship of the business. There
shall be no appeal from an unfavorable Determination of any such application,nor from a Kure to act,except for filing
by the applicant for a Special Permit from the Board of Appeals as otherwise provided A
D4/q t/ 1AAi 01/ /
Applicant Date
),i y " f) mj//'(!/
Print Name
DETERMINATION: The Building Commissioner,based upon a review of this application and information supplied by
the Applicant,he _determines that the proposed use satisfies the requirements of§406.5.1.1 and that the Applicant
not ap f a Speci 1 Permit under§406.50-5f,r/Cr.kaid-rgL I I
i 23/J`
Building Inspector Date Health Agent Date
Form must be filed with the Town Clerk and copies of this form must be sent to the following departments(as
listed in §406.5.4); Water, Engineering, Fire,Health,Planning,Conservation,Board of Appeals.
Aquifer Protection District Waiver Rev: 07/24
f}o,�Y'�t TO: Commercial Applicants in the APD
1 O.
(o ` y) FROM: Yarmouth Ileallh Department
` y:co
SUBJECT: Hazardous Materials
As part of the application process tbr a Board of Appeals hearing or Determination of Non-Applicability,
please complete this form and return it with your application. For further information concerning hazardous
materials regulations,contact the Health Department Office.
In the conduct of your present and/or proposed business,do you store,use,or generate any of the following types of
Products? Please check all which apply and list quantities.
Antifreeze,Engine&Radiator Flushes if/a Motor Oil /1 0
Hydraulic, Brake,Automatic Trans fluid A/0 Gasoline/Fuels /V
Grease,Lubricants /1 /
Degreaser/Cleaners Nerd/ S i i � l
f-,
/fit(%'6
Floor/Driveway Degreaser �f1/ Battery Acid /,V/N
Rustproofing/Undercoating PO Vehicle Detergents 0
Vehicle Waxes. Polishes //0 Asphalt,Tar,Sealers /V
Paint,Varnushes.Stains,Dyes,Thinners /V0 Wood Preservatives /t/
Dry Cleaning Solvents,Carbon Tetrachloride /" Floor/Furniture Strippers /" 0
Other Cleaning Solvents N/�P f�/ S Z Rock Salt,Road Salt aS /✓�°10aPev 17 /Or'•7G
Drain,Toilet,Cesspool Cleaners / _ Refrigerants /IV
Bug&Tar Removers Na_ Photo Chemicals /v 9
Printing Inks& Dyes No o Pool Chlorine /V V
Pesticides,Insecticides,Herbicides P0 Rodenticide, Fungicides /" 0
A��
Nitrate Fertilizer /V� Jewelry Cleaner /V
Leather Dees NV PCBs Nv
Electroplating Sludges /V ° Others(List) it/0
Applicant,signature: Date: af/9 f,eDo/1"---
Rev: 07/24