HomeMy WebLinkAbout2015 May 18 - Sign Off Transmittal Sheet, Plan - Pergola �oF;aR,�o TOWN OF YARMOUTH
o y :�y HEALTH DEPARTMENT
Y�^�•`` x PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: � i� /f����� �✓
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Proposed Improvement: �//J1(/lp, J�f T�f"9'O��
Applicant i7 Tel. No.: � no�ZS��
Address: h � C��}��� Date Filed: S � �' ���
"If you would like e-mar/notiftcation of sign ofj;please prwide e-mail address:
Owner Name:������
Owner Address: Owner Tel.No.:
RESIDENTIAL AND/OR CObIMERCIAL BUILDING
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements
For Septage Disposal and other Public Health Activities.
Please submit three (3) copies of plans, to indude:
(1.) Site Plan showing existing buildings, water line location,
and septic system location;
(2.) Floor plan labeling ALL rooms within building
(all existing and proposed) —
Note:Floor plans not required for decks,sheds, windows, roofing;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
....._..._................................................................................... . ................... .........................................................................................................................................................................................................................................
REVIEWED BY: DATE: �/� �i /� S
PLEASE NOTE
COMMENTS/CONDITIONS:
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� NOEX6TING UTILIiIES SHOWN ARE APPROXIMATE AND MAY cF � ' -'� 6'
NOT BE COMPLETE, ANY EXCAVATING CONIRACTOR TO c1'9� f\� � "� �� 5
NOTFY DIGSAFE AND VERIFY ALL UTILIIIES PRIOR TO ANY �
EXCAVATION ON iHE SITE. LC�� q��� � y
2. FlELD IOCATION OF GARAGE CONNECTION 9-12-2071 �� , ��
BY DCE, INC., INCLUDING INVERT INTO SEPTIC TANK, � �' ��
REMAINDER OF SEPTIC ASBUILT INFORMATION BASED ON < � ��'
TIE CARDS 6-7-2001 PERMIT //07-205. � l
3. BUILDINGS PER 2001 CPP LOCAl10N BY DCE, INC. � � � i� �' ���2` f
4. REF. 4/18/07 SITE PLAN BY DCE. INC. DATUM NGVD29 __�--k--� � i iQ-� �q
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JOB #00-112 ,-6_,\��/ � � ���' �•.
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SEPTIC ASbUILT PLAN � / �` �� � ��3 ��
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FOR rHE SOLE PURPOSE OF OBTAlN/NG HEAL rH APPROVAL_.�� � �� N� �' ����� ��,
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LOCATION ; 40 PLEASANT STREET ,.'F.\ �� � � �T\ �
(SOUTH) YARMOUTH, MASS. � S.y�°�F � � � \ ; p \`,
SCALE : 1" = 40' DATE : 9-12-2011 �'9Rsy �<',,` � ; �� �---
REFERENCE : P�N BK 45 PG f01
ASSESS. MAP 6f PCL 97
PREPARED FOR: ���,tNOFuass4
BR UCE DANIEL � r.4NiE� °y�,�
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off. 508-362-4541 OJA;.?, N
� faz 508-362-9880 v q No.40980
dOwn cope engineering, inc. R°F�s °a°' �'
(� CIVIL ENGINEERS �' � I N� 0�' �'\ �����, �
�� LAND SURVEYORS ' I '�� `�'j + '�— I��
939 main st. yarmouth, ma 02675 DATE REG.� LAND SURVEY�R