BP-64682Page 4
El Approval in Part (Per 780 CMR.5111.13)
$2 .00 A ,11D11,A7q70N FEE IS NON eE-FUN BIE NON-'f'.q I
Ia n DART MIRK-
& ARTMOUT BUILDING DEPART ��� �
400 Slocum Road, P.O. Box 79399on D' 9: 55
Dartmouth, MA 02747'
6N ORIWAT,tPNIft
1.1 Property Address: h .e t "G i t C 1.2 Assessors Map & Lot Numbrsr.
Lot Area (sf.) Frontage Map -�— ' Lot: --- l
Required Provided
Front Yard 1.3 Historical District El Y'es ❑ No
Side Yard
Rear Yard Year Built
❑ Altering more than 25% peer side of building
1.4 Water Supply(MGL c40 s54): 1.5 Sewage Disposal System: Has application been submitted,tto the Historic Commission?
❑ Municipal ❑ Private Well ❑ Municipal ❑ On Site Disposal System ❑ Yes ❑ No Date:
CONSTRUCTION LA SITE PLAN El E N EIR
GY REPORT
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