HomeMy WebLinkAbout2006 Sep 06 - Sign Off Transmittal Sheet, Plans - , _ . . , .. .. .}:�. . -� � � . .. , ��-. ,_•e - - . `�.�°�' .r » .,. , �' _e I :V��:.. .
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°��Y``'R� TOWN OF YARMOUTH
o� y HEALTH DEPARTMENT
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PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Appliccmt:
Building Site I.ocaiion: �� .S (��IJ S���rl6ZP- Map No.: Lot No.:
Proposed Improvement: JU �;
�C�� ��� i
Applicant: �'i c h�. �t �27�'ffn TeL No..Ur�(o �(oS3/
Address: �%D� fSau (39�! ,8t{�,�Skr_�1k�1�3' �(r+3/ DateFiled: 4A51�
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**IJyou wou[d like e-mail notificadion ofsign off,please provide e-mai!address:
Owner Name: �S f- vJ
Owner Address: Owner Tel.No.�S�—n�
RESIDENTIAL ANDlOR COMNIERCIAL BUII.DING
HEALTH DEPARTMENT: Detemrines Compliance to State and Town Regulations; i.e., Requ'uemeirts
For Septage Disposal and other Public Heahh Activities.
�lesse sl�bmitft��,4) copies of plans, to include:
(1.) Site`�lan showing eaisting buildings, water line loc�4ion,
and septic system location;
(2.) Floor plan labeling ALL rooms within bnilding
(all e�sting and proposed)—
Note:Floor plaxs not required for decks, skeds, windows, *oofinS;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
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REVIEWEDBY: DA'I'�: � C���
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PLEASE NOTE
COMMENTS/CONDTPIONS:
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SUNSET �RIVE
�] 40 ' WIDE - TOWN WAY
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SETBACKS : �� � � l
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1 HEREBY CERTIfY THAT � ��,���� �' '* `�`�'< � /
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THE DWELLING DEP/CTED ON TH/S �' (, �- '�x
PLAN WAS LOCATED ON THE GRDUND �� ,����� � , � pLOT PLAN
BY SIIRVEY ON JUNE 9. 1998 AND v ���q�{�q „_ , �N
EX/STS AS SHOWN AS OF THE DATE g_• �f��rX��< <<�
Of LOCAT/ON. �j` �t� s -- YARMOUTA. �ilASS.
U�ba �F.�� q
Y�'`�'�" ��� SCALE: l'-20' AUG. l4. 2006
7H/S PLAN /S FOR PLOT PLAN &�S�/7�,d G
PURPOSES ONLY AND NOT FOR �AGLE SURVEY I NG , I NC
RECORD/NC. DEED DESCRIPTIONS
OR ESTABLlSHfNG PROPER7Y L/NES. e23 eo�te sn
. Yarmeuthport, W. 02675
- (SOB 36N732
7HlS PLAN /S VOlD lF NOT �5°° 'ua�s�3
STAMPED AND SfGNED !N RED.
0 10 . 20 90 PROJECT N0. 98-055PP
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