Loading...
Appliaction & Permit 1998 THE COMMONWEALTH OF MASSACHUSETTS /JO477- P TV J MASSACHUSETTS ,1pplicatton for !isvosal *velem Construction Permit pplication is hereby made for a Permit to Construct(X) or Repair( )an On-site Sewage Dispo al System at: Owners Name.Address and Tel.No. lco,,gyL Coa nnzucr7o,j -51 C.4MPk5 PM-34- AMO$)Z.ST Y1h K/4- 25-6- 0321 / / Inslellers Name,Address.and Tel No Cot es. CLOG Ta+1f Designer s N Address and Tel.No. e1.A SgsGA-1C S577 �.(DC ,r=* ,/±75±7 I ocation Address Or Lot No. 9A. th ,t'/S Co/loos, J Dasw Cg IPOAD 'vpe of Building: Dwelling No of Bedrooms Cafeteria( ) Other Type of Building No per Persons Showers( ) Other Fixtures \ p �5 )esi Flow 9900 C1 �/ gallons per day. Calculated daily flow el bl,/ gallons. gn 9 Z3 Nan ca an Date 7/6/15 Number of sheets V Revision Date Title SePTZC SYSTEM /.M/nuT Pl At.) ADD/776444-f 5 /Description of Soil <FP PLrwS 12 (GOO b e3/oA) Garbage Grinder( ) Nature of Repairs or Alterations(Answer when applicable) Date last inspected' N/i4 Agreement: The undersigned agrees to ensure the const uction a system in accordance with the provisions of Title 5 ofthe vir Certificate of Compliance has been i.(ued by this Bpard H C� igned Application Approved by i Application Disapproved for the following reasons maintenance of the aforedescribed on-site sewage disposal mental Code and not to place the system in operation until a Ith. /iv / fig 71/ Date Date Permit No Date Issued THE COMMONWEALTH OF MASSACHUSETTS .\( T7 44- ,:-( MASSACHUSETTS Gtertifirate of (Emnpliunre THIS IS TO CERTIFY, that the On-site Sewage Disposal System installed( )or repaired/replaced( ) on j-.1 /<Li,. .f, ..ir<)5,•-J. � FT'oltr0Cca fcL.f- it has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No dated Use of this system is conditioned on compliance with the provisions set forth below: The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. This Certificate expires on DATE Inspector No. l THE COMMONWEALTH OF MASSACHUSETTS /'( MASSACHUSETTS !isinf Sustem ccoz}$trurtion lrrmit ( HJp C (L 64- E-Kri Permissiop is hereby granted to to construct( i of€epair(,,) On-site Sewage System located at FEE ' 1rryl and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special condit ns. All �construM pm p le d wi f of the dale below. /> ��it,G . DATE eDi .Approved w. L _ FORM 1155 Ra..B.95 A M SULKIN CO-BOSTON MA �, r"