HomeMy WebLinkAbout0019 RENOIR DRIVE - Health 19 RENOIR DRIVE LSE
Osterville
A 146 — 110
o `
No.•••-.....---•---- ---- ..._..:t.......
_
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE ��
Appliratiun for Dispusa1 Works Tonstrurtiun ramit (�
Application is hereby made for a Permit to Construct ( ) or Repair (X) an Individual Sewage Disposal
System at:
....1.5.... x? ...... ......................................
.............................•---... ...........................................----------...--_..--------•--•----------..-..--.----
Location-Address or Lot No.
�L
,i!� g 9 ---=-----------•--. vv---- � i2�3 j�L1,�...............................................................
..__._... - .....-•-•.............
Owner Address
w kAkt tacit oA 3�:R_....._a - `r^�s„r Q.0 - �'. 1-36 csp:!N tLV�.U�.
-._.......c r
1.4 Installer- Address
UType of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms...................................:........Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of persons............................ Showers — Cafeteria
a Other fixtures -----•-------------------------•--••-------------- .
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
9 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................
Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
-__-_ Diameter.................... Depth below inlet.......___._._.__._. Total leaching area............._....s ft.
Seepage Pit No--_---------------- p g q.
Z Other Distribution box ( ) Dosing tank (
Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................
(T,, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P4 ...............----------------- ...............
O Description of Soil b z :.._Sv ........................................ --------
.t" ..la.
x
U
w
x ..............-.........................................................................................................................................................................................
U Nature of Repairs or
Alterations—Answer when applicable....OJO-ID......0 0A..`_--1 f_v o -Q.....CR.'O~!-La_h7..__. e1(VA
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance has been issued by the board of health. r
Signed a.--.-- .... --. - --C " -------------- ........... Z Y(--pt
Application Approved By ---__ .... %
Dve
Application Disapproved for the following reasons- --------------------------------------------------------------------------------------------- ------..............................
..
----,-y-------------------- -------------------------------------------------------------------------------------- a/ /--�
----..------D------f-e-------------------
Permit N ..--...... Issued ........................ I y� ......t
t
19
No....---•--•---��---� Fes$..3. .�........_
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE �Y f l
Appliration for Dispoiini Workii Tonstrurtion f.amit
Application is hereby made for a Permit to Construct ( ) or Repair ( X) an Individual Sewage Disposal
Systeml at
.... 5..... .►JG�-= -•--. SL11�. ...................................... ------------------------.-----•-----------•-•-----•----_-.-.........------------------r Location-Address �• or Lot No.
- Or.� `razz fRx�.:s -- �5 .......
- ...............
Owner Address
a ............................1t .�'o a 3�.�....�'d.�- -z"�Cam..-----------•..... : jc --t1 ...•...c�r+�C c���.�F............
Installer Address
Q ' Type of Building Size Lot----------------------------Sq. feet
V Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of persons............................ Showers — Cafeteria
QI Other fixtures -----------------------------------•---•--•--
-W Design Flow............................................gallons per person per day. Total daily flow............._.......................:.....gallons.
GG Septic Tank—Liquid capacity..._-_.....gallons; Length................ Width................ Diameter................ Depth................
xDisposal Trench—No. f ° Width.'__'.,..... Total Length .... ... Total leaching area....................sq. ft.
Seepage Pit No.............. ...../Diameter.........L 1 1Depth bel"ow inlet r () J.......`Total leaching area..................sq. ft.
Z Other Distribution box ( ) j()D(') Dosing tank O
aPercolation Test Results Perfofinedtby° ......-1.........................................----`--•- Date........................................
Test Pit No. li_---------------minutes per inch Depth of Test Pit........ .--.----- Depth to ground water-----------------_......
rX4 Test Pit No. 2.............Aunutes per inch Depth of Test Pit.................... Depth to ground water........................
•---------------------------------------------••-•-••-••-- ------..................._.............. ........•-••--....••••••--..........----•-.....---•----' !
O 1 Description of Soil......... •^1Z ANJ C-t................--� — e LL•!► � "
v ......................................................._:......................,: ----••......------•-•---------•--••---•-•••••-••-----------•--.............-----..............-•--------•-•...
W
-----------------------------------------------------------------------------------------•------------------------------------------------------------------------------------------------........-•----
V Nature of Repairs or Alterations—Answer when applicable_... ....... ....4.'...... <w`
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance has been issued by the board of health.
r Signed `"" \A.j -""ati--y-�'--. �, \::..--�'.-C........................................... ........
Dale
Application Approved By �.... j.,� f
Date
Application Disapproved;for the following reasons: :`
.vt
...........................................---------------------------------------------------'-------.......--------------------------------------------------------------.......""•------..-......--------- ----------------------------------------
Date
Permit No.
---- -�`� -'- Issued " �f�.�?"� -----------
THE
Date � i
i COMMONWEALTH OF MASSACHUSETTS
I BOARD OF HEALTH
TOWN OF BARNSTABLE
Cerltfira a of (VILToMPliance
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (/%e�
Y ...----'-----------------'-----"--------"----.......--'-"-------------'------------""'-''----------
at .
lns[aller
`.....' - r►0�-Q_ " "-' R 1 V C........ " .......... 0 5� -..
.- ' " " '
has been installed in accordance with the provisions of TITLE 5 -f The State Environmental Cole as described
the application for Disposal Works Construction Permit No. ..... 1 .. `.... F� dated ....;-.- _*.....��..../-----�'"= �
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE........ '' .......?17....�.. �------. ............................. Inspecto - '' Ord 2/� - -'`'`yam!
V
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE `_V
Disposal Works Tonstrmfivit Orrntit
Permission is hereby granted....µ.` .`�Fy'...... d"�5�...._............_..�.�!"''�....
to Construct ( ) or Repair (,k) an Individual Sewage Dis osal System
atNo.......(. ......`Z �? �`{L......_.Q .lv. .................05 ...-•--------•-•--------••................................................................
Street .�+'
as shown on the application for Disposal Works Construction Permit
s,N(-7,�''.�•�-. �ated.._.` "'......` �..........
C-,
/ /�
. .- --ram•...- ._
_ yy // �� Board of Health J
DATE........ ..._....y.... f
FORM 36508 HOBBS h WARREN,INC."PUBLISHERS
TOWN OF BARNSTABLE
LOCATION I .t�l.�/b^ J",'ae e- SEWAGE # a<
VILLAGE O�I, ,TIIp ASSESSOR'S MAP & LOT
INSTALLER'S NAME PHONE NO.
SEPTIC TANK CAPACITY /600
LEACHING FACILITY:(type) (size)/0,0® 6"1
NO. OF BEDROOMS PRIVATE WELL O UBLIC WATER
OR OWNER �av� I� �zQI►eS�
DATE PERMIT ISSUED:`
DATE COLIPLIANCE ISSUED: `� �
VARIANCE GRANTED: Yes No
y
QL.
N
L D CAT ION yS.I W G E PERMIT NO.
7
VULLAGE
SI(A LER'S NA & ADDRESS
® U I L.D.ER
OR OWNER
DATE PERMIT ISSUED
DAT E COMPLIA.NCE ISSUED.
` .. ,
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i
P JO���
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�� � �
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A• `'Ato...°:. .�.y/,<.. . Fz$.... ®..:...........
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
- OF............. 00
Appliratiou for Bhipoii ai Works Cnonotrurtion Vantit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual 'Sewage Disposal
System at: ".
----------------------------Z.......I........_..... ..`��'.......... - r �. N ....... -
Location-Address or Lot No.
.............. --------•-•-----------------
wner Address
a .................................... 414......�j�It 3�•6���...............
Ins ller Ad ress .
Type of Building Size Lot....... _-..cl---`7Sq. feet
Dwelling—No. of Bedrooms..........__�-------------------•__•-•_Expansion Attic ( � Garbag4 Grinder ({&
Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
a' Other fixtures -------------------------------- -
W Design Flow................. .................gallons per person per day. Total daily flow.............. ,_y.o.................gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width---------------- Diameter................ Depth................
Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No--------------------- Dia eter.................... Depth below inlet.................... Total leaching area..................sq. ft.
z Other Distribution boxes Dosing tank ( )
Percolation Test Results Performed by--------------_---------._r.= f..1,e.......e� Date............
a
Test Pit No. 1....: minutes per inch Depth of Test Pit-_____-_- , --•• Depth to ground water.... f�
f=, Test Pit No. 2.._... �__._minutes per inch Depth of Test Pit....._._ epth to ground water........................
...............
-----------------------•---•--------...------------------------....f.-•••-•-•-_... ..........................=!rn - _
O Description of Soil................................................... ........................ '�? �----/-() ��- - --.. ....-
w •-•--•-•-•-••-•---------•...........................................................F---- /-�-------- -----; . . -- 5 _
•--•--------•-- -•----------•--•-----------••-•••••••--••--•---------------••--••••-••----•-----••---•-•••-••-••--------------•--------•---•-••••----•-••-•--•----••-•--••••............-•.......---•--.
U Nature of Repairs or Alterations—Answer when applicable...____.........................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agree not to place the system in
operation until a Certificate of Compliance has been issued by the boar o health.
i .. -----------••---•---------• -•-•--..
ApplicationApproved By ....-=�---. ---- ............................................................... .... •...••-- -
Date
Application Disapproved for e f of wing reasons-------------------------------------------------------------------------------------------------------------••--
-------------------------------------------------------------•-•-•••••••-
Date
PermitNo--------------------------------------------------------- Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.. ..............OF........-.--...,.../'.
Appliration for Bhgpoiial Works Tonfarurtion omit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
�rt-z
System at:
,rLocation-Address Y y or Lot No.
.............................
Owner Address
a ..................................... �F.,.!_' s!....._... a!,:! .,a.t..y�� .....__.____________---_.___.._....... ....... . .,.._.:!�e_-
1-....
Installer Address -.
d 'Type of Building Size Lot_______ feet
U Dwelling—No. of Bedrooms_____________ __________________________Expansion Attic (�) L.�' Garbag4 Grinder (<)42
`4 Other—T e of Building No. of persons____________________________ Showers — Cafeteria
Q' Other fixtures ---•----••-•-•------••-•-•-•---- -
W
Design Flow................... ...............gallons per person per day. Total daily flow................. ...............-gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter________________ Depth................. .
x Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area..............------sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box,(._. Dosing tank ( ) -
`" Percolation Test Results Performed by---------------------------------------------------_ �. ".:'�:f._-�y�.:°'~Y. .'__ L' Date............ ,.... .............. ..
aTest Pit No. 1...... .. minutes per inch Depth of Test Pit_________ ,:: Depth to ground water.... et..,1_
44 Test Pit No. 2...... n R.nunutes per inch Depth of Test Pit._.____. __:K____-Depth to ground water________________________
---------------------•-------------------•—--- = ---•--- •-- `= ..._ ..
J 3
Description of Soil t a._._.... 'b..�,_._._.. ° ---'•------------------r P le ---- .
W ---••--•-----------------------------•-•------•---•-----------•---•--•-••--•--------•------------•-•--•-----..__..._.-----------••---••-•----------•-----•--------•---._-••-•-----••---•------••-----•-
UNature of Repairs or Alterations—Answer when applicable_______________________________________________________________________________________________
------------------------------------•----------------------•-•------------------------....•-•_•-••--•-•------------•----••--•---•---------------•-•---------•--•------•------•-•------•-.._.__......•---
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees,not to place the system in
operation until a Certificate of Compliance has been issued by the board'ofjhealth. ,
d
Application Approved BY ` 9 b� -- - ---------------
Date
Application Disapproved f o the f owing reasons------------------•---•---------------------------------...---------------------•-------- •-----•---•---------
........................................................................................................'................_.............................................................................
g
Date
PermitNo......................................................... Issued---------------------------------------------------
Date }
THE COMMONWEALTH OF MASSACHUSETTS
�...-- BOARD OF HEALTH
(Irrtifiratr of Tomphattrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal, System constructed.(�') or Repaired ( )
by .... _ -
Installer�
_ r I�.... .�
has been installed in accordance with the provisions of T T LE j of The State Sanitar '4Cod s cribed in the
application for Disposal Works Construction Permit No�,3"__,:_��_________________ dated�_ __�1_ ._ -.______.____.__._._.
THE ISS-' NC OF THIS CERTIFICATE SHALL NOT BE CONST AS A GUA ANTES THAT THE
SYSTEM L F CTION SATISFACTORY.
DATE.... ��.......•-•-••••-••-------•-------------••--•--------•---•--- Inspector•- .
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OJFZ HEALTH
-- f
<1r 'al"` .........OF...............��'. er'r :U.. �.. ...!__...F:....._..
No• --=�_-_:.....l ./.:.. " FEE' ........--•---
Dispostt1 Vorks Tonstrttrtion trutit
Permission is,hereby granted t ...,,f ..t - !' �' ? '- -` --'-'..................................•-------..
.( ) '__ ( r> a -__- :.0 g ` posal System
to Construct � or Repair an IndividualrSe�Sewage Dis
atNo.........................== = -1 i '� C ' ;�-/•••-•-.........
1 �.
j ( �t L.�- i�✓ Street ,/
as shown on/thea;picati for Disposal Works Construction Permit No _ .__.. __ Dated.l ___'`: , �..............
................•----• •- •------•-•---•------------------•-•-------•--......_-•----..._..---.....� -- --- Board of Health
DATE----- --------------------------
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
4 57 ODU
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EGEND .µ
EXIS1'IMt3 SPAT EL Vr0.TIQN 0':6 4 '`
, CERTIFIED PLOT : PLA1 �
EXISTING CONTOUR`~--- a �::_., ��cHo�aPq !_oT SPOT ELEVATION'. 08 �R YFINISNEDCON �QUN.F
Q � �w " BU.CET
APPROVED BOARD* OF: HaLTM � ;�caREn � -� IN
DATE At EAI T,,, �Q sv `+� 'Si
CALE / 46 DATE + s✓a s -�
L 'L�C�Cy� E/VGINEERIAIG CO /N I CERTIFY THAT THE PROPOSED
.._ DLIENT
EGf51'ER . REGISTI�RED JQp,•Hb.,' BUILDING SHOWN ON THIS :PLAN
clv�L Lew® F cQNt=o �ss . TO. THE z®9dlt�( t_�► +s
OR. Y `
E'6�t�IN.EER HV � 'OF :I3AFttdSTASLIE,. AAA:"S I
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No. 3..: .... Fxs.... ...............
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
.............d...�..�`.'................OF.............lC..!—P....".. .��r LC........
1
App iration for Disposal llirkii Tnnitrnrtiun ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
Syst at
..... '1�-�.......... --------•-.�- ......... 7 -a - lJ ....-- ...............
Location Add ess , or Lot No.
7
Owner n f Address
a .............. - .. 5.........._ .l _J(. .C..Qf.../ ......__._.......... --.------•----•-••---
Installer Address
d Type of Building Size Lot_.... . S
U DwellingNo. of Bedrooms................ ............_.__.._...Ex Expansion Attic— p (/�(� Garb�e Grin r
a Other—Type of Building No. of persons............................ Showers
a YP g -------------------•-------• P ( ) Cafete
� Other fixtures --------------- ---------------------------------------------------------------------- ---------------------------------------------•---...---------
w Design Flow........................T5......__gallons per person per day. Total daily flow................. -----.----.--gallons.
WSeptic Tank—Liquid capacity(00W1ons Length................ Width................ Diameter------------_--- Depth................
x Disposal Trench—No. ................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No..................... Diameter----................ Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box,, Dosing tank ( )
Percolation Test Results Performed b Eep
Date ......------•---..----
Y......................
Test Pit No. 1...:L�.g_j_minutes per inch Depth of Test Pit....... tfi to ground water-___noes fi4
GL, Test Pit No. 2.._.._.. 4` ilinutes per inch Depth of Test Pit-------`_-___--_.__. Depth to ground water----.... 0'wH�2�/4
P4 ----------------------------------------------- -----------------
Description of Soil...................................(� Z It---------- Ge
'^----- •---------------
w
'- - ......................• . As......--------wx 9..-----------------------------------
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
U Nature of Repairs or Alterations—Answer when applicable...____.........................................................................................
- --- ------------•-------------------------------------........_....------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLL� 5 of the State Sanitary Code— The undersigned further agree t to place the system in
operation until a Certificate of Compliance has been issupj by the board o health4
1-following
gned. ' 4------
Application Approved B�or
- -- -----------•-•-•-----------------------------------------..._---•-- •----- --�.y- ,.._..._
Date
Application Disapproved t reasons--------------------------------------------------------•---------------------------------------------.......••--
...............•--•--------•--._._...----------------•--•-------------•--•--------.......------•-----
Date
Permit No.......................................................... Issued..............
.........................................
-----------•------•---........_
Date
No.93."..`f/5 F�s.....1/6).................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
........
Appliraiion for Uhipaaal Works Tonitrurtion "omit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: _:F: = .-------
r
Location-Address or Lot No.
......................__--•-•---•---.........ti............................. .....................-----_.. ...... ._-• ....... -• ................
o- Owner .. - Address
---•----------------•-••-••-••-=•.•-•_. ....----.......... . . _.. : ...........-••-•--••............••. .r....._... .� ................
Installer Address
d Type of Building Size Lot......(.1. 0....✓._��__S
Dwelling—No. of Bedrooms...........................................Expansion Attic ( �°)'p Garba e Grind ,?
PL4Other—T e of BuildingNo, of persons............................ Showers — Cafete • _
QI Other fixtures .........................................
W
Design Flow......................__-5_______-..gallons per person per day. Total daily flow...............�.�._.�`!............gallons.
WSeptic Tank—Liquid capacity AAjCgallons Length................ Width................ Diameter................ Depth..............
x Disposal Trench—No...............:..... Width.................... Total Length.................... Total leaching area.....................sq. ft.
Seepage Pit No..................... Diameter........_........... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box,(,.-. ,
ox„(''' Dosing tank
Percolation Test Results Performed b --! �e ...._...t�...'..��Date........................................
Test Pit No. 2__..r... `'n nuts per
er inch De Depth
t of Test Pit.......1�_._� _. De Depth
th to ground water---.
f3, Test Pit < p p p g
O Description of Soil .r._...._....�; = `T '•---F- '`r- `� '----=--------•------------
/ .� ,.'!.
-+{ ,-/-J- //'' /) ,
W ........................................................................................................................................................................................................
U Nature of Repairs or Alterations—Answer when applicable...._....................................................:.
--------------•---...-•-----•--------•---•-'...------••-------................---•--------•---------------------------------------------------._...-•-------------•---------_•---.
Agreement:
The undersigned agrees to install they aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITI.1r:, 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
�- " �-� - •--• • ��- ....................
-------------' / -=---..�
Application Approved BY- -
-------f- - ---'-- -------�`^---�---�---� •------�-------- -= Date
Application Disapproved a following ------------------ :
--- ....................
....................................................... ---------------••-•---••-------------------•••-....--•----•-••-----•---•----------•••----••-------------•----•-•-•-----•-----•----•--------------
Date
PermitNo........................................................ Issued•.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
........................
Cwrrtifiratr of Tomliliianrr
r` ,, �.r C I ndividuallS,ewage Disposal System constructed (�'d� ) or Repaired ( )
THIS IS TO CERTIFY, That the In ��
b ......................••---- . '.-•• ..................................................................................... •,.._._..
C *' ° Installer
L r
at.. ... _ .......... `---- rsL �i ,..._------� -------=-----------
.......
has been installed in accordance with the provisions of T j,c�fThe State Sanitary Cows e ribed in the
application for Disposal Works Construction Permit No.. .................................. dated. ,� �. ..... ..:..........___._.__
THE ISSU CE F THIS CERTIFICATE SMALL NOT BE CONSTRUED GUARANTEE THAT THE
SYSTEMU N SATISFACTORY.
DATE.........-•/ .. --•--•.-•...........................•--•-._..__..._••.... Inspector........ ------. --------•••---••----•--•..........--•---.......-----•----.......
THE COMMONWEALTH OF MASSACHUSETTS
1 '
r. ._.
BOARD OF HEALTH •T
.. ,.
.......F. Iw {'.......OF.................................................................................... �i�L�
No.---._--•. .:.......... FEE.-:...............--•---
�to�oo�i
Permission is hereby granted......_ � {%
to Construct..(-' ror Repair ( ) an Individual Sewage Disposal System
atNo.................................... - - != t !, r lf� _ ' _ ............
• �"� l (Street `
as shown on/thheapn for Disposal Works Construction Permit N _.'y� Dated�y.�......_�....�................
--------•-•-•-•-•-•-----•----------•----------------------------------•----------..................----Board of Health
DATE------ --
FORM 1255 HoeBS a WARREN,, INC.. PUBLISHERS
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No.10951 O a
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�FSSIpNAt
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