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HomeMy WebLinkAbout2009 May 28 - Sign Off Transmittal Sheet - Deck F*�* -nm a�°R„ :r ... ,�°��YA��o TOWN OF YARMOUTH � y HEALTH DEPARTMENT N�,��,,,�•�'c�'� PERMIT APPLICATION SIGN OFF TRAN5MITTAL SHEET To be completed by Applicant: Building Site Location: �v Q��,/�( � Ma No.: ��d Lot No.: dd��? � � r �— / ; Proposed Improvement: <`C ��l�C' d- ' rI��.n � j � 1 � } 1 � Applicant: '�cy. � ' �J ..� Tel. No.: S'4� ��� -- 1/�,7�r ; ' Address: d�� � - Date Filed: � �'_� i � **Ifyou would dike e-mail notification ofsign o.Jj;please provide e-mail address: / � C � Owner Name: G�cy� � Gc%�?� � i Owner Address: �a ����_�� ,�,��,� Owner Tel. No.:j p�—7'3?^-y9�d ......................................_.._......................_........--------�---..........................---�--.................................----...........................................---...........................-�---�------._.................-----........_..---......----........----......_------._............... 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 four (4) 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 ezisting and proposed)— Note: F[oor plans not required for decks, sheds, windows, roofing; (3.) If necessary, Title 5 application signed by licensed installer with fee. ....--��-�..................................................................�---�--....-------�---.................................. ��---�-----......._..........�....�-�-----...............................................__................ -..........--....................................._..........--�---..._..........._........................... , REVIEWED BY: L;� DATE:__ �--.� �`"G° � PLEASE NOTE COMI��NTS/CONDITIONS: / `� � l , �' � � 7. 2 - N � ' . RAYMO�tQ . . _. ,r, , R f►�'t t t ht G �� ` }'`� a _ _ . � _. _: m . � � ? -t. o s �_ o T 2 � ,a ;,�-� t` � � - �� � 0 ` k � �'`` �`�� ; o � -,� ����� � � zo� � �,�� � �v , � � �' � %i'e i�J:/ �;� �� i��� f` � C3 � �'� 1 ;r; �p U 5� �rQRRG Z�_.� 7'� ipc��iD' _" __� p�?t O'N . .�--- ----- -: `,�:; y i y.._-_ 34 t APP' Rt)V� D 2 45. 80 MAY 19 2009 Q L D S A L T L � <����,�--� �•=� `�"+�'S `IIGHWAY �'�0 ToP � F FC� lJNDATION Lp�,o.r,,o,v� `�ARMOf1TN MA55 �,S � ' A80�lE N/CN �C 4.L!� : " D+�i T!�►: .�eG`�'lL�t�a/tat �!�1.V T !�t/ R r3/1 D B�t NG SNOW N A5 �aT� 20 � 2 r s N � C p 34�G1 '� SNE�,T � o � 2 � ; :; aET v ��P' 2 �,,�,�K'°�"� - 2 l.►tt�I1►� Q�fT�t Y TiVi�T 7".K/i ItJ✓LDi4,�♦ o'�'� �Yf.RFtT it. C ��+�� 04/ 7�"�Iii /K.A�I /� LOt�f"ttJ ��I 77►.+1 �' 4tPIC.cI.tY s'�`�''�►.s •�r :.www ��ur�av .o.va ryv.�r .r � �,,, ,,,r� , , , �r�.;c. ., ._.. tav�o�w,.o ro nv����l�� "".� `.L 4 - r' � a� � ��� � � � a �'. '�*.��^ � � ws.r�.v ccwar�crc r�a. -,, :.....,� . �;�=�.":�..�'' _ E G.. d �f �' �IV� L L. � /� � /�1lG. � ,% � r Y ( Y A,C M C�t!T ly, Mr! 31. .-- =-��._.._�..� • v�re► � � ��� Commonweatth of Massachusetts Title 5 Official Inspection Form Subsurface Sewag�Disp�sai System Form-Not for Voiuntary Assessments 30 Old Salt Lane, Yarmouth Port PcopeAy Address Michael Ferro 8 Faith Hallet �� ownera Nsune ���"�'� 2 Elm Street, De�nis MA 02838 Janu�ry 8, 200� requirod for every paga. ��Yn'� State Zip Code Date of Inspec�iOn . D, Syst�m Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposat system in:luding ties to at least two permanent refe�ence landmarks or benchmartcs. Locate ail wells within 1(0 fest. Locate where public water supply enters the building. �,,w+...t h.. .� L �Ff Si6c �j \ ,-�CJ� � � � ��;�" � � : y 9 . Q �= 28 �� , ,, p = 3y - � ____-- F - 58 ' � ` Yr� F� �I '6'' F = S3 ` , O . �� � _� . �� � . , � . . ,�. . � • . �� : : � Q � - -, �, - � � � . � � . - , 3o Oid SeM larr,Yarmplh Port•03p8 . TitN b 011fdW Inepectinr►Fam:S�asfea Sew�papoul S� twp•Paps 14 of 15