HomeMy WebLinkAbout2016 Apr 19 - Sign Off Transmittal Sheet, Plot Plan - 2 Decks ,�--..��� __ r�_ �-_,.��
a��Yq� TOWN OF YARMOUTH
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HEALTH DEPARTMENT
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� �'�"`���°`�'� PERMIT APPLICATION SIGN�OFF TRANSMITTAL SHEET � �
To be compdeted by Applicant:
Building Site Location: �.,.��/''��� -���
Proposed Improvement: �.Z� ��'�i'
Applicant: � �.. � �✓'o � Tel.No.: ��7 9aG s�.3--��
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Address: � �T/.�F'l.rc/ .� �-�' Date Filed: �iS'/zc�6
**If you would like e-mail notaftcation of sign o,f);please provide e-mail address:
Owner Name: ,�..�-' � `"�
Owner Address: � �,??.� .�.��� Owner Tel.No.: ��
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RESIDENTIAL AND/OR COMMERCIAL BUILDING
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements
For Septa.ge Disposal and other Public Health Activities.
Please submit three (3) copies of plans, to include:
(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.
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REVIEWED BY: DATE: � /7 ���
PLEASE NOTE
COMMENTS/CONDITIONS:
A.M. : 79-88
DEED REF: 28421/350
PLAN REF: 183/57
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D IAN E AVE N U E �40' PRIVATE)
Yarmouth Health Department
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WROCK'S SURVEYING
I HEREBY CERTIFY THAT THE �ZH��
STRUCTURE SHOWN ON THIS `� �''i�
PLAN IS LOCATED ON THE DOUGLAS A. s SCALE: 1" = 30"
D AS SHOWN H Eo WROCK PLOT PLAN
No. 39054 DATE: 4/19/2016
� �F�ISTER�-���� 8 DIANE AVE.
�j°f6 Fss�qyq� �pNOS SOUTH YARMOUTH, MA PROJECT#: 14099
DOUGLAS A. WROCK, PLS DATE SHEET 1 OF 1