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HomeMy WebLinkAbout2016 Aug 23 - Sign Off Transmittal Sheet, Plan - Barn , � . . . _�.r _ .�.._ �...�„ ,,�,.v��....�..��„s,-... � . �.t ����::�.-�..� o!��'�a� TOWN OF YARMOUTH .�-�� �� ��-,°, HEALTH DEPARTMENT o...�;. , - , � �:'�,�i �.��'. -�-E' PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: Building Site Location: �� 7 1Y�1Z.`f7� �t�lr� �p( Proposed Improvement:�`on,$�"YvC � c� ��/X 3� �r r� �on -�e �x c.� �e ��#- C'�Y v� cr �� -�,r c�roy�e.f�i Applicant: �ii�u� �. �_,�-►,�oh�.(� Tel. No.: 7��'a 1�-33 a I Address: ��G� ��Q �i- �e�.� J�ru1i?�� Date Filed:_�7"`3 /�. **If you would like e-mail notifrcation of sign off,'please provide e-mail address: Owner Name:_ �J�,�/1 ��l� 0�1� Owner Address:��? /��c,�T/-f �,�►-t•-��S ��� Owner Tel.No.: �11�-.��1`�'_���� ' ......................:...........:.........................:................................:.................................................................................................................................................................................................................................................................... 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 locatio�; (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: � v'�,3 / � ; PLEASE NOTE COMMENTS/CONDITIONS: � � ~ � ���� R r J�� � &Wl' Certified Plot Plaxx� I ���� �O�X Lo�d�o�. o�Q����;��J� SURVEYING • ENGINEERING ¢z7' Nortlt 1)enni.s Ro � efffGHl��,4y HOME PLANNING&DESIGN �'d�"'l�202GtIt, 1TI�I pTepdred for 8 GIDDIAH HILLROAD �(zn2el LumOnt PO BOX 439 SOUTH ORLEANS,MA 0266s _ 505-455-8814 SCaLE: 1"= 50' www.ryder-wilcox.com I]CLte• July 5, .201 fi ' 195.33' � - _ � � � Lot z � EXISTING � �re�.• � DECK �0,OO¢ S.F�- � , �o.9> �r�.f� � ��y 68�� EXISTING � '�� SHED � C� a' 2= 0�' PROPOSED U �� � GARAGE � �'� }3�" � �� � �g)� •N� ___ __ _ . _ --- - ' � ____ _ --- � _ . _ .- , - _ _ ___. �o '�� `�_ �� SEPTIC_PER �4� � ._� � 'f B.0 H. AS-BUILT :;.��:� �2,6 � i :`�' N � � o� .\ � � � �o ���`� .����� a—�..�,.,� St ')'7" � '�;. .. ; i ��"�s N �ORK MUST C FO I�� 0 AL q�� $ ?ofs � TOWN BYLAW & GULATIQNS ���KN�M��rH � Re,ference.• Assr's. �� >3s, YARMOU�'H �'�°��"'�aY �l z4 ER DEPT DAT ��������-. RE�E�V�� A(�� � _ . I certify that tlte dwelling sltoum hereon is locat,��l/iV�;g,� A��i � � 2�1� it exi.sts on ttae g�urtd and tlr.dt as so locdted it ' 1'A��j `�'+ omplies witli the mirairraum prn�erty line setback ��r' = HEALTH DEPT. Quir��rtents of the Town of uth. ��������;, ...;_ � ' -"��� �����,H ��y Ddte: 7/.�//G Pro ssional Iand Su �!�� ��!'_1P � -;�� .f� rveyor , �, ,�:�� '',�'•�.,, '�u�s � �� �� ':i�6 �;,�:.:��_ . ;=FTI �' Job No. »705 �; •� i,r-�ir;;'�;7 „ ' i- �� ?P , � �Fss�° Q. ��'�SUFtv£�� r`_'�;� ��G,,