HomeMy WebLinkAboutMiscellaneous - 1779 GREAT POND ROAD 4/30/2018 (2)MAP # -LOT # 17 --if 7
PARCEL # STREET. ... .... ......
go A,
1121
CONSTRUCTION ARP_ ...'..._ate
- L1,0,
HAS PLAN REVIEW FEE BEEN PAID? "YES
NO
PLAN APPROVAL: DATE APP. BY
DESIGNER: PLAN DATE,_____
CONDITIONS
WATER SUPPLY: TOWN WELL
WELL PERMIT DRILLER
..........
WELL TLS -TS.; CHEMICAL DA I E RPPRUVED___.___..__._.___
DAIE F1( I�RUVL`U
BACTERIA II APPROVED
COMMENTS:.
FORM U APPROVAL: APPROVAL TO ISSUE YES NO
DATE ISSUED BY
CONDITIONS:
FINAL APPROVAL:
ALL PERMITS PAID YES NO
WELL CONSTRUCTION APPROVAL YES NO
SEPTIC SYSTEM CONSTRUCTION APPROVAL YES NO
OTHER YES NO
ANY VARIANCE NEEDED YES NO
FINAL BOARD OF HEALTH APPROVAL: DR
o � s
r
• 4 ss,. � r �
'fir ^�••.� ^�4.1�!
�ss.,c Muss
Permit NO:
Date Issued:
LOC.xTION l�
PROPERTY ONNNE
Nm,w NO.:
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXANUNATION
IMPORTANT: --1Z
Gr P(A P0'P
PARCEL:
icant must
5
Date Received: L`
all items on this
� 0't yr �.
Print
ZONING DI)TRICT:
TYPE AND USE OF BUILDINGHISTORIC DISTRICT YES 0
TYPE OF IMPROVEMENT PROPOSED USE Non- Residential
Residential
New Building One family
Two or more family
Addition Industrial
Alteration No. of units-
Alteration
Repair, replacement
Assesso Bldg_ Commercial
Demolition Others:
Movingrelocation = Other
= Foundation onl
DESCRIPTION OF WORK Tn BE PREFORMED
01r) LT �OPJT
OWNER: Name:
rdpntiGcation Please Type or Print Clearly)
S
Address: I � �% r P � P� r k
CONTRACTOR Name:
Phone:
;address:
Super%isor's Construction License: _ Exp. Date;:
Home: Improvement License: Exp. Date:
1% (�nt6 Sofb
11RCFTITEC"C. E':CItiEER \.ime: 'hone:
FEE iC'I�EDCLE: CLJI.'G PC'If,bllr: SiU.; Ut ER j 100.i'06F HE TOT 3L �STVTATED C 1�ST.IAS.ED 0,°:
x10.00FEE:'
T+►tal Proj(xtCost:$____�
:'.,.,e 10, .4
r"!
T1'PE OF SEWARGE DISPOSAL
_
Tanning Massage Body .art
Swimming Pools _
Public Sewer
_
Tobacco Sales --
Food PackaLylnp- Sales
Aell
_
Permanent Dempster on Site
Private (septic tank, etc. _
Electric `Teter location to
project
NOTE: Persons contracting withlnnregisterf ' contractors do not /rave uccess to the guuranly.Jrrnd
Signature of Agent, ONrner , `%..�r�' , /r'� _ Signature of Contractor
Plans Submitted - Plans Waived ` Certified Plot Plan - Stamped Plans
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT
COMMENTS
DATE REJECTED DATE .APPROVED
� J
❑Water Shed Special Permit
El Site Plan Special Permit
Other
DATE REJECTED JDATE APPROVED
CONSERVATIO - 2 12CU�
COMMENTS
DATE REJECTED
HEALTH
/X
COMMENTS L--( c
l.,oning Board of Appeals: % ariance. Petition No:_
,)nin, Derisi,,�n rcco t,tibmirfcd ;,:s
tmnm4 8•tarcl unments
_ .:�tf.�l'\:ll:'�il rl:•:I' I'; n: �_::n1nlCllrti
,Ute
nF-AJi"pAer .;(_ itu - - �o -- .-,re rcPartr. ent ;i`n,au . luC —
3uilding c t rrnit .\pprvx,.:d Lind ISAKA by
DATE APPROVED
TOWN OF NORTH ANDOVER
BOARD OF HEALTH
CERTIFICATE OF COMPLIANCE
DATE OF COMPLIANCE:
3/30/00
This is to certify that
the individual subsurface disposal system
constructed ( ) or repaired (X )
by
F.P. Reilly & Sons
at
1779 Great Pond Road
has been installed in accordance with the provisions of Title V of the State Sanitary Code
and with the North Andover Board of Health regulations.
The Issuance of this certificate shall not be construed as a guarantee that the system will
function satisfactorily.
Board of Health Inspector