HomeMy WebLinkAbout2007 Apr 26 - Sign Off Transmittal Sheet, Plans - Addition'+�cy�-^i--•'.o�.�-�^�.:€+.---..-.•�..� .r.,+rrc�z�,,�,-p.s-7Fc.;.�`"m`. , .a� . . . . � -,.: , . , � _ _. . .�,,...�,rs�:z.....r,,�+.-.��*.,a��:�-. -.c -
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,�°��Y`��o TOWN OF YARMOUTH
o _ y HEALTH DEPARTMENT
: '��"^����
c PERMIT APPLICATION SIGN OFF TRANSII�II"ITAL SHEET
To be completed by Applicant: '
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Building Site Location:G�-� � ��'� ��--�� Map No�� Lot No�:��
Propos�d Improvement:t�� G�� 1
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Applicant:�..,��l'Z21 ��✓��Q �f'Y'1'� " Tel.No.:�G:-�'J ��
Address: l��Q�-�� Y�l��.���1 ��,,.� ��� ( �„ Date Filed: � ��
**Ifyou would like e-mail rrotifica#on ofsign o,fJ;please provide e-mail address:
Owner Name: ��.�..���� �
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Owner Address: � �I� �r Owner Tel. No.: �-�--
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RESIDENTIAI.ANDJOR COIVIl�IERC�AI.BUILDING
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations�i:�, Requ'vrements
For Septage Disposal and other Public Health Activities. '
,z`S �°'''"_
Please submit four(4) cop�es of plans, to include:
(1.) Si�e Plan shov�ng ezisting buildings,water line lt�tion,
a"�d sep�c-�ystem l�ation; � -- �.� �""
X; �,: �(2.) Floor plan�abeling ALL rooms within build�ng
(all ezisting and proposed)—
Nate:F[oo�pla�es not required for decks, skeds,windows, roofing;
{3.) If necessary, Tit�e 5 application signed by licensed installer
with fee.
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REVIEW�D BY: � DATE: �� �/'
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�, P�ASE NOTE
COMII�NTS/CONDITIONS: "� �`�
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176•�� �
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� MAP 58, PARCEL 134 0 �p
N � #5 CLEAR BROOK RD. � C�
� �, YARMOUTH, MA '
o �P� , 22,i 69 S F.
ti
PROPOSED �P O �
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ADDI TION
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APR 2 6 2007
sEPnc srs�M sHowrv HEALTH DEPT.
IS ORAWN FROM AS-BU►LT
ON FltE A7 THE TONAV
HEALTH DEPARTMENT
CER TIFIED PL 0 �' PLAN
KELLEY RESIDENCE
1 CER7IFY THAT THE IMPROVEMENTS SHOWN aF y ,{5 CLEAR BROOK RD.
HAVE BEEN LOCATED W►TH AN lNSTRUMENT ,��,P`'�� �ss,��y YARMOUTH MA
SURVEY. �? ROBB s DRAWN: RBS
DATE: FEB. 6, 2007 J08 ,�: E00750
o SYKES ^�', SCALE:1"=30' W CPP
� No. 354t8 �' EASTBOUND
�'� ���,`� � LAND Si7RVEYING, INC.
'' `�s� �S P.O. BOX 442 '
ROBB SYKE , P.LS DATE FORESTDALE, MA 02644 :
508-477-4511 :
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