HomeMy WebLinkAbout2016 Apr 05 - Sign Off Transmittal Sheet, Plot Plan - Deck o�'�R�,� TOWN OF YARMOUTH
; �� - _ `��� HEALTH DEPARTMENT
� °-,' -- ,�
' � �`'���ME`' ' pERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
�
E To be completed by Applicant:
,
Building Site Location: ����-�� ���
. ,,
Proposed Improvement: �Z k' 23- �
APPlicant: v �-- Q .✓.a- � Tel. No.: �/�,1oc� ��.�/
Address: ��i��?,.�-��' �G� Date Filed: c 2o i.�
*�Ifyou would like e-maid notification ofsign off,please provide e-maid address:
� Owner Name: ...- �'✓, ��`-'�zz�'��
Owner Address: ,-'',�i�',T���` ���..��- Owner Tel.No.:�''��o a_���
.......................................................................................:..........................................................................................................:................:................:...................................................................................:.........................................
RESIDENTIAL AND/OR COMMERCIAL 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 include:
(1.) Site Plan showing egisting buildings, water line location,
and septic system location;
(2.) Floor plan labeling ALL rooms within building
(all ezisting and proposed) -
Note:Floor plans not required for decks,sheds, windows, roofang;
(3.) If necessary, Title 5 application signed by:licensed installer
with fee.
........... ......................................................................�U�2/............................ ....:................................................DATE .................................�....��..............................:.................
REVIEWED BY: �f -
PLEASE NOTE
COM NTS/CONDITIONS:
R
__ _ _ ;
,
.
A.M. : 79-88
DEED REF: 28421/350
PLAN REF: 183/57
_
i
�1 I �
� 122.00' o i
N O I
z3 � " PROPOSED DECK � !
15.0 ,
RETAINING WALL �Z �
RETAINING WALL �
o � �
O �
� #8 DIANE AVE p
�, i�,ol.�J�
i
�B�x � `
�� �
� _ FENCE �
�
� �cf� � '
�
m
- 122.00' � €
I
G
D IAN E AVE N U E (40' PRIVATE) k
.- i
Yartnouth Heaith DepArtment �
ED �
�
;
�
�m� Date '
;
I
f{
!
�
I
WROCK'S SURVEYING i
�
I HEREBY CERTIFY THAT TH �,ZH�F j
STRUCTURE SHOWN ON T ��� ��G,r�, G
IS LOCATED ON E v DOUGLAS A. s SCALE: 1" = 20" �
GROU AS S 0 N RE N. WROCK PLOT PLAN
No. 39054 DATE: 4/02/2016
�O,Fs'�FcisTER�-°���� 8 DIANE AVE.
.z zm�(P S��A� �A��S SOUTH YARMOUTH, MA PROJECT#: 15001
DOUGLAS A. WROCK, PLS DATE SHEET 1 OF 1 �
�