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HomeMy WebLinkAbout2016 Dec 20 - Sign Off Transmittal Sheet, Plans � _�� _-�-_rx _ -�.�,,.�- _ _ T, ,._ _ ,: _ .. �_ „ - s. . � o� 'rak TOWN OF YARMOUTH r ��� �; ��-� HEALTH DEPARTMENT o:.,� __ +� �'�~�'��,.�����"x PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: ""� Building Site Location: �'� C�,�T S��h \� v 2 � � Proposed Improvement: / o ►• S �. � `j t�a�Y�t s t-o b c vCcw.e,.c.4, 1.�.•.� � b �i f+ ��,'�-rti. Lvir.�.�� a�.yC L�o ie -�—� iC}�� , �-5�i ��-i�� Lv�v��.o.�. S s..� QCs 2 +R-c r..o,ic� T� Ma�c.r B t`4�k f:S t �R �2 r S 1' S 7'�/����r Applicant: �i--�lt y—�t, e s j �,,,� �,..r N svrr b�.. ���..-� -t h c_ Tel.No.: �'d�$-2 3 '�-I J �a Gi��-r� +.��].o ��C. Address: p. �. j3 n� 1 S 3� �. O� 1�tiL S , t'hQ. CS�� v 3 Date Filed: 6 �_ **If you would like e-mail notification of sign o,f�j;please provide e-mail address: Owner Name: C h �'�Y I � e r� t- Owner Address: 2� C a�t` S�h��y t2�c. Owner Tel.No.: .S�a$-7l o- � 7U 7 . ..........:..:..::..:...............................�.......y�r..�_.,T►..,....►�..�........:.....�.::�.:.G...�...y..........................: RESIDENTIAL ANDlOR 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 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. .......................................................................................................................................................:...................................:...........................................................................:...........................:.......................................:............................ REVIEWED BY: DATE: /�d-✓/��' -�--T �.. PLEASE NOTE COMIV��NTS/CONDI NS: . � � ` �S� � Rz'v'�.�c � I���d e�.,�� -.:� �s . _� �� i' �� . � ,'� { S �:. �' ; ��,� � 1\1�O �� ,��� : , . . � ; ,— — — — ..._ .--------- .._.. . . �� � — — � - �-----j� l� ; �,'� _ I .�.�. _._. ;� e :\ ; :n,,� � i • ,. �.� , � { � `-� =-_._� �' � ---� �, -� �- .,;-� � � � a ;'� —o _ .r --� j,� ;� (� �. r�___-----� , i / I, � ! t , �: � --� ' � I ' '!j ; �l! 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TA� " ; i I _ _ . __ R V Certif�;ed Plot Plan � zo�at�.• �' "� D� ,28 C¢1vtdin Stanley Rc� �/�/ Yarmoutf�, MA SURVEYiNG � ENGtNEEWNG p�epared for HOME PUNNiNG&DESlGN Cfieryl 1Yent Scale: >"= 30' 3 GtDDIAH HILL ROAD P.O.BOX,{39 I�Qte' 1�'ebT1Ld77� ��i zQ�a� SO.ORLEANS,MASSACHUSETTS 02662 TEL:508.255.8312 FAX:508.240.2306 f20.DO' � o FOUNDATION � � � � �'_ � 54.2'f � _ FiELD LOCATION �y 34•5�t ., , � OF SEPTIC TANK � � �� _r_� AND D-BOX � � 1� 1�h , � � �x F��� � � O y .� r� � j EXISTING LEACHING � Z� � 1 FIELD (PER SEPTIC � o c� � INSPECTION REPORT) � � �44.5' � ` � 1 LOT 399 �- � >,2,600 S.�:f EXIST. � 0.29 �c.f � SHED � � � � \ f20.00� ���e, � b - �Issr's. map sy f�l. >so �, ���Z;1 flF t„iqs� - . . •� DAVID c'�� I cef�i,� that the ,�undac�ian shourn � A. � hs�so�ts locatad as if ezists on the � LYTTLE " � ,o #34620 ., � �eF�SS��a l,q�� � �p4 ni Zf6.' �3 2�L3 A%�ssiorial �nd .�urueynr � �`J dob No. »0,22 ; ; I