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2017 Apr 07 - Sign Off Transmittal, Plans - Garage
�:_�a-�-�. .-F, . __� �.��.�__��,�� ..�r_._.��. ���..�,�.-� -�.�- .o�'Ya� TOWN OF YARMOUTH ,� .�-�.� �; � ;X�;�° HEALTH DEPARTMENT o:..t,. ::.._ _ -,-� ��''���%��$ PERMIT APPLICATION SIGN OFF TRA.NSMITTAL SHEET To be completed by Applicant: Building Site Location: /''' li� �' '��.�'.�'7D Gt� Proposed Improvement: f� � ��- .�� �CI ,G--�42--. �- � i �d'{ APPlicant:�o d h�,�c/� , ��C _.� �..1� Tel.No.: �� � ��'.S—'�'' Address::� f�'.�7 S,� � .� �. a Date Filed: /l 72' **Ifyou would like e-mail notification ofsign off,pdease provide e-maid address: Owner Name: �,h � �''��'".� Owner Address: �� �� . � ,� �.c,� Owner Tel. No.: �`3 �— S"�.�~g i .........................................................................._...................................................................................................:.:................................................................................................................................................................................ � 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 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: ` � / l ' ' PLEASE NOTE COMMENTS/CONDITIO1�S: / t�c�-�-� u-t L t /tcJ�,c-�-► �!d�t�¢... � � rA✓�. �c. v .�e. G h�'✓a-( ( ' e � .z _ v_. �`.,�.!^e-1 �'S.a4�J�,t�'�-.• . � '� � ' , . . . �..� . s-s'R. �'•(� _ �L:1i.ri..:1��►, <�. � � �.' `��. ► _: •�•: ' �. ' .• � _ ' - . _ . .-. ' . . � ' _ .J ' • '^�" _a..'. , . .�c °'t .i 'yY� r;�����.':)�S'�..Z. .. > t . 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DAYE/{,t ph'r:r::�,;�:=--=ti:•��:. i t I � � Page !0 of 11 • (3FFICIAL INSPECTION FURM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DiSPUSAL SYSTEM iNSPECTION FORM PART C SYSTEM INFQRMATIUN(continucd) Nroperty Addrrss: l8 Avery Lane South Yarmontb�MA ' Owaer: Manucl Cabrai nate uf tmpcclion: Feb['uary4,2003 SKETCIi OF S�:WA4�:DISPOSAL SYSTEM !'rovide a slcesch utthc scwage disposal system including ties to at least two permanzn[rrtrrence fandmarks or btnchmarks.Lacaer alt wells within 100 feet.Locate wtiere public water supply enters the buildin�. � ,..�s.. ,.�� r ; 13..�k ���o�..r�.� jU� / 1' , /f NKr � � z3' � � �g, ; 33'�'� ,6�, i? i i � 'G" F U � f G s kS I � ��Y��, �� � ���.'�.. I � � � t ( IU � ; ; 9