HomeMy WebLinkAbout0086 SETH GOODSPEED'S WAY - Health Ex�ad,� ,s ��
No `------------ F>�s.. ��....................
THE COMMONWEALTH OF MASSACHUSETTS
- � BOARD HEA
.-
.OF..........ffPf
................. . ..... .
Applirutiuu -fur Uiupuuttl Workfi Towitrurtiuu Vrrmft
Application is hereby'made for a Permit to Construct or Repair ( ) an Individual Sewage Dispo al
Syst-------t. ---- � -,._.....
ocation dre or Lot No. e-
.... ... -• ..................... ..... ...... . .......... .......................... .................•..... --�...................
c O ! e Address
....................... .....................................................................
a /° = �- ---- _
Installer Address
d Type of Building Size Lot_�`5�-_��'2._-Sq. feet
V Dwelling—No. 'of .Bedroom ............................................
sExpansion Attic ( ) Garbage Grinder ( )
a
p, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
a' Other fixtures ____ _ .._.'__........_
W Design Flow--------- _____� ._ allons er erson er da Total dail flow............J_�2-. _ .-.-..-.gallons.
g � ------•----•-•------•-g� P P P Y• Y - - - -- g�
WSeptic Tank—Liquid capacitWd gallons Length---------------- Width------.._.------ Diameter------.--------- Depth----------..._.
x Disposal Trench—No. .................... li._.--___:___--______ otal h......... .I------ tal leaching area....................sq. ft.
Seepage Pit No../�_ _ __ ____________________ piet-ep-,"'?
__.______._._. leaching area_.. ..�.sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by----------------- ........................................................ Date---•-•----•-------------------------.---
W Test Pit No. 1----------------minutes per inch Depth of Test Pit-.------------------ Depth to ground water-----------_-_.--.----.
ri Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water-_._-._-_____--_-___----
9 ---------•-•--------------------------------•-•-------••---...-------•-••-•--•--•-•----------------.........................................................
0 Description of Soil------------------------------..................................--------------------------------------------------------------------------------------------------------
x
W ------------------------------------------I---------------------------------------------•-------------------------------------------------I-------------------•••---------------------------------------
UNature of Repairs or Alterations—Answer when applicable.---------------------------------------------------------------------------I---_-----.----.....
---•--------------------------------•--•-•--------••---------------•----••-•-•--•------•---------------------------------------------------------------•---•------•----•-•-----------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI 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_ e bo r2ofh. �Ith.
9
Signe
a f
Date
76
ApplicationApproved BY............. �AC...--------•---•--•-•---•---•---------••--•-••-•••---••-----•--------. -------------4C- --34V -----
Date
1/07
Application Disapproved for the following reasons:----••------------•-----••------•-•-•------------------••--•----•-•-------•-••--•-•-------••------------•-------
---••--•-••----•--•------••----•---•------------------------------------•---•---•-------------••---------•--------••------•-------------------•-•-•------------•---••--- ----------------------------
Date
PermitNo.......... ............................... Issued........................................................
Date
THE FOLLOWING
IS/ARE THE BEST
IMAGES FROM POOR
QUALITY ORIGINAL (S)
M �A
�c
LI
DATA
No......................... Fnnc... C/....................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
_ .....r: .... •- !LI ._o F ........:.:-r':.'....../..?' -' ... .---.....-_..---------------------
Alip iration -for IN!ip Y ial Works omitrurttott Punift
Application is hereby"made for a Permit to Construct (�) or Repair ( ) an Individual Sewage Disposal
System at:
.411
•----------------•---------......••--------------...•••..........-•••-••-••••..........•••...•-- ................................•-•-•--•••-•••••••............•-•••-•-•••-....�.
Location:Address - or Lot No.
-i..... ..ti-..tom..•
! Owner Addresy �'e f
Installer Address .!
Type of Building --� Size Lot--._-!..'___-/•___--____-.Sq. feet
.-� Dwelling—No. of Bedrooms............ "'----------------------------Expansion Attic ( ) Garbage Grinder ( )
a Other—Type of Building __--.--__- No. of persons Showers —
g -------•---------- 1 ,-� ( ) Cafeteria ( )
QOther fixtures -- '•'`'`. .'"'------------------------ -----------------------------------------------------------------------------------------------
W Design Flow.......... ___f'�_____________________gallons per person per day. Total daily flow....._........7__0_--�-__-..-----_-gallons.
9 Septic"Funk—Liquid capacity?/d4 1_gallons Length---------------- Width---------... ... Diameter................ Depth................
W Disposal Trench—No. .................... Width------------------_--Total Length------------Z_... Total leaching area------------------..sq. ft.
Seepage Pit Diameter ' `"'..._.. •6Depth'bel w'%fii t"'" _`_s" Total leaching area._"__G. .._.sq. it.
Z Other Distribution box ( ) - Dosing tank ( ) c'
Percolation Test Results Performed bY---------- -------------------------------------------------------- Date----------------------•----------------
W
Test Pit No. 1_-___________-_minutes per inch Depth of Test Pit____________________ Depth to ground water_.____...-.---.--_.-__--
(14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------
Ix ----•--------------- --------- ---•-----------------------.................................................................................................
0 Description of Soil------------------------------------------------------------------------------------ -------•-----------------------•--------- •------------------------------------
x
V .....--•---------•-•----------------------------------------------------•--•-.----------•----...------.....-----•-•----... .......----------------••---------•---•-------------•---•----------•--------
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 Article XI 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.
Signed------... --- . /f . . !� e1�-^-y-- �
----------------•------•--------•------•---------------------- ---------------------------------
Application Approved BY-----•-----�--/6------------------------•--•---•---------------------------------•--- ---------------�'Dat 0 --7G.
Date
Application Disapproved for the following reasons-------------------•------------------••----------------------------•-•-----------•----------------•----•--------
------•---•-•-•--- -------------------------------------------•------------ ----------•--------------------------------••-------•..........
Date
G
PermitNo......................................................... Issued--------...............................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
r BOARD OF HEALTH.
. .....................OF.......'...... .���.................' ......................................
Qlrrtif iratr of Arum iattrr ,,/�
THIS IS TO CERTIFY, That th'e Individual Sewage Disposal System constructed<--) or Repaired ( )
b 1 .
,, .
f..__ i! Installer,
' = ---------------- -------- ---- -�------ --------•--•----••--•-----------------------------•-----------------------------
has been installed in accordance with the provisions of ArticI, XI of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No-------�_-_ dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A•GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE------- ----------- Inspecto -----eSETTS
. ..................................
THE COMMONWEALTH OF MASSACH
_ - BOARD OF HEALTH
FEE._. •-----•-•-•
N.nVwial lVarkni Cnottstrurtion rprmit
Permission is,hereby granted if�___� �!-' _'
to Construct (,--) or Repair ( ) an Individual Sewage Disposal System'."
at No.................. 70
�' =r ! -------.--_.•----••••---•----------—------------_.=� ---- ----.-.------_-------------------------------------
Street
as shown on the application for Disposal Works Construction Permit No
- Dated____ ____=7_
J -----------------------
Board of Health
DATE ------------------
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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-T'1-lls t7L.At_I IS �.1oT 13ASE:17 vt..� i�u c>��E�'v1t...t_G v l�r\ASS.
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t•tc,T a` �scq �� ocr�Ptilt••i� LoT u►.��s , CAPE WIDE. lZt=✓ (:�o--- ----
ASSESSORS MAP NO:
PARCEL NO.. c3 0
THE COMMONWEALTH OF MASSACHUSETTS � k ��� g�?t> CJ —
E®AR®.��®J��7F HEALTH a!�
�T Gr iil p
...........OF....... ....- �
Appliration for disposal Marks Cnnnstrnrtion ramit
Application is hereby made for a Permit to Construct ( ) or Repair (/`} an Individual 'ewage Dispo al
System at• .
................-........-........--------.......:•-•-.._......................`... ---------- ----............-••------..._.....----------•----- Igr
n� Cation Add or Lot o.
--_.......... .......... -•^-- -....-----------------
• ----------
-------------
e ddress
............... ... ..... .....
............ ..`.....`.............--_... _•_____._.. ...•- _•__ . ....................................................
FM-1 Installer Address
VType of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
a
� Other fixtures -------------------------------------------•-----------
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. J"
04 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter..............__ Depth................
Disposal Trench—No..................... Width.................... Total Length-----"........._--- Total leaching area_...................sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area_.-.......:.....sq. it.
z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date............................----•---•---
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water--__--_-_----__--___--.
0:4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--------- --------------
-- l ..-•-----------------------------•-------------•------'".............
Description of Soil....................... -- - - ------------------------ ------ ....... -•k" = . =
U --•-----•-•-•-••--...-----•..............•-•- ----•---•-•--•---------- =
W
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 i T i T:%- 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.
Signed.............. --- ------- ........................................................ ....---------
` Date
Application Approved BY............ . ..........
. Date.......... ------
Application Disapproved for the following re ons-................................................................................................................
.........-•---------------•------....--•-.....--••----••--....------•---------••-------------•----------.•------•---•---•---•-••--•-•-••••--•-----•----•------•----------------•----•--••-•------:_...._
Date
Permit No......... , ._._.. Issued_..__�7' Z ��' at
Date a
N.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
( --- -----..........OF............ } -~ ............-.............
Apo i ' ation for Disjum al Works Tonstrurttnn Prrutit
Application is hereby`made for a`Permit to Construct ( ) of .Repair t" ' an Individual Sewage Disposal
System at
........................................6 ..... ;,� ,
----------------------
L cation dk Ad or Lot No.
-
- Ad
dress
...... .............•.............. h_\— f l� .•......•..----•--•-
Installer I Address
d Type of Building `" Size Lot............................Sq. feet
Dwelling—No. of Bedrooms-_'.........................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ...A...................... No. of persons........._.................. Showers ( ) — Cafeteria ( )
d Other fixtures ............
-••••-•- ----------------------------------------------•--•---------- ------------------•------•-----------. =-
W Design Flow............................................gall ons per person per day. T8ial daily ow................................ 0
04 Septic 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 Perform&—lby....... -`:---........ .............�-------------`___...-_' /Date......................................
Test Pit No. 1................minutes per inch Depth of Test Pit....._._....•....... Drepi0to ground water......................
' 1 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.........................
O Description of Soil..................• % ' .------
W ---•---------- ------------•---••---- --_._....------------•----- - -----------•------......--------------- -------- --------------------•--....................
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 T.1 p 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.
Signed..............
Date
Application Approved BY +!'t L ----------•---•. ..:.....:.:....... ..
�I `DateE ....
Application Disapproved for the following re ons:
.............••-•••-•-•-••-•--•••--------....----•...--•••--•-----•-•-•--••--••-•--•-•---•...--•----••••-••-•-•-•-......._..--•---•-•-••---•-•-•----••••-••--•--•-•--••------••••-----••--•-._........_.
Date
Permit No....... .. ..... ......-----J........--.-_ Issued.. L., ....
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF(�.HEALTH
.....tD... `1 j
Trrtif iratr of ToutpliFanrr
THIS,IS TOWE
T FY, That the Individual Sewage Disposal System constructed ( ) or Repaired }
by .....-- - .......:... = t.. •`.�. -
fjInstaller
.... ............ ...................................................
has been installed in accordance with the provisions of TiTi� j of The State Sanitary Code as describe n the
application for Disposal Works Constriction Permit No.-.-...,'��--�--`-1-64�.`. t...... dated----- 1.�"_ M-" ----------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT YHE
SYSTEM WILL FUN TI N SATISFACTORY.
�rti
DATE...................... �'. - ...................................... Inspector....................................................................................
..4
THE COMMONWEALTH OF MASSACHUSETTS
BOARD �OF HEALTO
1 . „
}
1 e
NW...................... FEE
�i �r�aa1 a• �nnnrin Apr i
Permission is hereby granted..................... _..... ........................................
t Go �oonstrfrac or e r an Indwldu SeK Disposal-- ----- ---•-----------------------•---------r-----------------------
0 Street
V .. ✓
as shown on the application for Disposal Work Construction Permit No �_- t L•. _. . Dated..... .....1�` ........
Board of Health
DATE........
FORM 1255 HOBBS & WARREN,,,INC.. PUBLISHERS
I)bESSORS NIP NO:
N� 1 Fes$.. �..
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
.............OF....� 1� _.,v r � .
App iration for Disposal Works Tonstrurtion Frrutif
Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal
System at:
........•---......---------•-----•----•-••-----------------.......----------------•-...............
Locatio Address or Lot No.
Y .................................... ......................•-•-•-•---------....
Owner Address
a _DUST
InstalIer Address
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms...... ............................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fixtures -------------------------------- .
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
1:4 Septic Tank—Liquid capacity............gallons Length---------------- Width................ Diameter................ Depth.............
Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area.____-------_____---sq. ft.
3 Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by---------------------------------------------=----•....................... Date........................................
aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------
--------------------------------------------------------------
W
0 Description of Soil-----------------------------------------------------•----•---•--•------------------------------------•---------------•-----••-•------------------------............._..
x
W
- ' � -----------------------
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 i T'�11 is
p of the State Sanitary Code—The undersigned further agrees not to puce the system in
operation until a Certificate of Compliance has ssued be d of eaea th.
ned..__.
y
Application Approved By-•••-......-•--•-. ------��-: !._: ...................... .............
Date
Application Disapproved for the following reasons:-------•------------------------------------------------------•-------------•--•-----------------------••-----
------------•------•-•-------------------••----•------------......--••-•-----------•-----....-------••-•----•-----------------••-----••------------------......•-•-----•------•--------•----------------
Date
Permit No '��......L-_.( 9._._.... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
Appliratiutt for Disp.autt1 Works Tomitrurtion Vautit
Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal
System at:
LL,ocat, ;%Address or Lot No.
t? •
......................_.......... .............................................................. .........._.......................................................................................
/ Owner Address
_.. i:� S/
Installer Address
Q Type of Building ---� Size Lot...........................Sq. feet
Dwelling—No. of Bedrooms........-5...............................Expansion Attic ( ) Garbage Grinder ( }
Other—Type 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.
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water-.--_-_-_____-_______--.
(14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a •-•-•-••••--••-•-•--•-------••--••-•-•-•-•---•--••-•--••••-•-•-•--•-•..................•-•--•-••••--.........................................................
0 Description of Soil........................................................................................................................................................................
x
U -------------•----•------------------------------------------•----------------------........--------.....---•-----------------------------.----•-----------.......------------....•--.........----------
w __
-------------------------------------------------------------------------------------------------------------------------- -
x ........ -----: .L .9 G s1
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"TLE y g g p y
5 of the State Sanitary Code—The undersigned further agrees not to lace the system in
o wee issued by the b,and of health.operation until a Certificate of C has Compliance x-> s f
P P � .�-
Dat
GApplication Approved By............=�... � - :. .----�..-o`'-----....•------- ----- �....
Da e
Application Disapproved for the following reasons---------------••----•--.........----•--•---------------•--------------- ---------•---------••••-•-•-••-••-••--
.---------•----------•---------------•--...--•---...-------------•--------....------------....------------••••-•--•-••-••--•-----•------•-••----•••••-•---•-••---••••--•-•------...••..................
Date
Permit No... _.__.___. L G
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
G�............o F..' !9,)�.............................................
ST.s-1 z 'cam .
.................
C'rrtifiratr of Tnutpliaurr
THIS IS TO CERTIFY, That the Iry.,'iividual Sewag�Disposal System constructed ( ) or Repaired
Y v a ..-' �:G..
nstaJler
at.•--••-••••-••-•-•---••-•---•------•-••••••--•-----••----•-.........••.............. ..,.....I----------------------------------------•-----------....---•---•----------.....----------------
has installed in accordance with the provisions of TT of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No...........................2 _�1_.. dated-------tt.(
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT YHE
SYSTEM WILL FUNCTIO A ISFACTORY.
DATE......... -[.� l Inspector.... 1------------•-----•--•-•---------------------••-•-•--•-•-••-••----•••-
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
r 7
N FEE..
t �aalarku �4attttrUau rrutit
Permission is hereby granted............ .v :.C_.�...
.....................................................................................................
to Construct or Repair an Individ Sewage Disp�osa1 System
at No............ � C � rJ 6 p o�Sr'g_ �
�/
....---••-....... ....•--......._--•-- ----...-•---•---------••--••-••••-•----•••-•••--••-•-•-•-•-•---•--•-•••••............................
Street
as shown on the application for Disposal Works Construction Permit No: _ Z.1 .._ Dated_.:____-- _� .._.._._....
------------------------------
Board --- - --'�c.-
DATE of Health
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS',.
y
TOWN OF BA`RNSTABLE �
LOCA"I ION SEWAGE #
VILLAGE O S Tf GZ!'/ I/ ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NO.& l _2 2 S-/ 2 ,:L
SEPTIC TANK CAPACITY /0 p a 6.9
LEACHING FACILITY:(type) 2 A,Airs (size) G r 0 0 oG, )
NO. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC WATER/'vb//C
ReLDER O-R OWNER
DATE PERMIT ISSUED:
DATE . COMPLIANCE ISSUED: i f
VARIANCE GRANTED: Yes No
Cos
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L-OCAT p SEWAGE PERMIT NO.
VILLAGE E
I N S T A LLER'S NAMEi ADDRESS
B U I L D E R OR OWNER
`,D-A-TE PERMIT ISSUED
DAT E COMPLIANCE ISSUED It l
S:P
LOECAT10 SEWAGE_ PERMIT N0.
?61 2
VILLAG �� � - Paz-c;%;
INSTALLER'S • NA E & ADD. SS ;. '
B UI DE R OR OWN
t
DA T E P E R M I T I S S U € D � '3�
DATE COMPLIANCE ISSUED
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