BP-66607RESIDENTIAL ❑ Phasei
r� DARTMOUTH BUILDING D
400 Slocum Road, P.O. Bi
Dartmouth, MA 027
Phone: 508-910-1820 Fax:
Board of Health:
Conservation Commission:
Signature:
Signature:
Signature:
Signature:
Signature:
1.1 Property Address:
Lot Area (sf.) Frontage
Front Yard
Side Yard
Rear Yard
1.4 Water Supply (MGL c40 s54): 11.5 Sewage Disposal Syst(
❑ Municipal ❑ Private Well 10 Municipal ❑ On Site Di:
El CONSTRUCTION PLANS
-5o f T �M
ess Phone Number
ess Phone Number
License Number:
Expiration Date:
on:
SIBLE FOR THEIR OWN PROJECT
e provisions of this section; provides that if a Homeowner
land on which he/she resides or intends to reside, on which
ise and/or farm structures. A person who constructs more than
is application. Failure to provide this
ffidavit Attached: ❑ Yes ❑ No
imney/Fireplace ❑ Woodstove/Pellet Stove
afing/Siding ❑ Other
(Specify below)
❑ Demolition
(Specify below)
Other