HomeMy WebLinkAbout2017 May 12 - Sign Off Transmittal Sheet, Plan - Porch �. z�
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a�-'Ya� TOWN OF YARMOUTH
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:�'-',c HEALTH DEPARTMENT
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Y��'''--=�=`%��� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: � ���,�$f��,�i'"� y`�°
Proposed Improvement: ,a/f't� f� � �7 p/ /4'/i S�Q �/�1J�/,�'i°
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Applicant: / Tel. No.:_��� �3l/�' t�.Slf�
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� Address: �Y' ff�` � k � Date Filed:��.� �`/�
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**Ifyou would like e-ma' notification ofsign off,please provide e-maid address:
Owner Name: /`/ 1
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Owner Address: �/�+p Owner Tel.No.: ,S`� y/�,{
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RESIDENTIAL AND/OR COMMERCIAL BUILDING
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e. Re uirements �
, q �Far Septage Disposal and other Public Health:Activities.
Please submit three (3) copies of plans, to include:
(l.) Site Plan showing existing buildings,water line location,
and septic system location;
(2.) Floor plan labeling ALL rooms within building
(all existing and proposed) -
`' Note:Floor plans not required for decks,sheds, windows, roo in
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(3.) If necessary, Title 5 application signed by licensed installer
with fee.
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REVIEWED BY: DATE: �.. 1�.. /��
PLEASE NOTE
COMMENTS/CONDITIONS:
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� � LOT 16 �,
� � 11,563.9 �- S.F. �
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I �rr��S� 64.82'
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,�-t'�`��'{�Cy ' WEST DRIVE
ROSIN � . ��� � 6 SOUTH
WILLIAM `��'• ROBfIV c�'�, `•
w�!cox n WlLLIAM `�'� � Q����d�D
..a� R:�. 31341 � VI/l�CC?X ; '•
�'�'¢����STE¢������ �° �No. s��a�o o MAY i 2�Ot7
as S��- � '$,�� �� � �.� o(�c,
�d�AL LA�?� �'S�Q��S T�R�Q-J �EALTH DEPT. '
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TO THE BEST OF MY INFORMATION, ��EXISTING�� PLOT PLAN
KNOWLEDGE, AND BELIEF THE SOUTH YARMOUTH, MA.SS.
STRUCTURES SHOWN ON THIS PLAN LOT 16, LC 18413D
. NAS BEEN LOCATED ON THE GROUND DATE 1 i�/i f2015 SCALE i" = 3�'
AS INDICATED. JOB 7648-00 CLIENT HlLL
�� � �C ��� SWEETSER ENGINEERING
//201 203 SETUCKET ROAD
DATE PROFESSIONAL LAND URVEYOR Po BOX 713 SOUTH DENNIS, MA 02660
OFF. 508-385-6900 FAX. 508-385-6991
� C: I S8 I PROJ I 7648-00 I dwg I 7648-EPP.DGtTG � 2015 SWEETSER ENGINEERING