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Home My WebLink About2017 Aug 24 - Sign Off Transmittal, Plans - New Deck .��-�Ya� TOWN OF YARMOUTH ,� ' '""�`;� �; ' :%��° HEALTH DEPARTMENT ; �;� �. - -!� '� ��'' `-4�� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET � '~�'-=-"`' � To be completed by Applicant: Building Site Location: � Q/� �ll� �C� �`, ...�� jj�'J� (/� Proposed Improvement: �rt'(,t,� � P�.' (� ""'"" Applicant: Tel. No.: �d��/Jl f�� Address: �� Date Filed:�� **If you would like e-mail not ication of sign off,please provide e-mail address: Owner Name: �e�'`l� t U� �Q g�c�� ;+ � Owner Address: /�f(��!� J/- �. ��/�•� Owner Tel. No.:`1��' �'� a � �� ....................................................................................................................................................................................:.....................................................................:....................................................................................................... RESIDENTIAL AND/OR COMMERCIAL BUILDING HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements For Septa.ge Disposal and other Public Health Activities. Ple se 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 rtot required for decks,sheds, windows, roofing; (3.) If necessary, Title 5 application signed by licensed installer with fee. .............................................................................................................................................................................................................................................................................................................................................. REVIEWED BY: DATE: �/�� PLEASE NOTE COMMENTS/CONDITIONS: ��rt s �v�v sz- �<< rt--� �c ��J r. . _ l I,F� c- �v c��' z—cc.� � 1 i � � �-^ �' ��'�'� s� :t,� : m�; � �E€ �� '`��"�«�� ..�.�z �--,,.t� �� f . 'I, ��"s �Y lv�.�� 'J;�;"'�� r�..�.... 1 L'� _ .z�c_.e �:: . - � ""`` ��a�.�''-`-'`�i: ; _�"`•, � � ��€ �� ,9 �, " �._._—_--__ .__d__�`'.._ �------ —-... ._ ..._.. � � � r F r�'s'�. ___ � . 4 . � w°"��F��..-.....v.....,...ya�f�. ��'•� ��•F+J"A'V`<iroc.vez . i ' �- ��.� _ '��." - � _�� :�r� � � . .�� ,,. 'c,..�°:'`� '—f` ' -�.. �-.- �..__..._._..___.. . .. _.._. _�; • �� ±��.... �:; � � ` ... �3�,�"s.��i�^.;: ' .t';t''�t� .�d'i t;#£�e.�. ' ��,� . . . F 4s �.E:'a2"�`°�' �f:�;�.��--�—�.. _... -._ . --�--_...._�. ; . � '$��'^", ��` f:a :±F� `��, {`"� � �� - � �'. — � , . t�'�'" � _ �:' c� �� ` � - "i`,�'t� ° c.c�.,�� 5 _ _ _ . . ,� ��; . �6� �� Y�:.•.� ,ttt��''R--F.� .... _ .... .__.---.. k . � . . ___,__,..,, F s # � �� . . t � .. , , � i . . _ , •tX f p�.��a�� i�. �� AUG 14 2017 HEALTH DEPT. " Iv �� "� � ,� t� � I __ � ! f I � c i f �:.. �� `�• �� l�f�� E � � � � ' � �`'"�"�'`��C' ��:��'�. ;�� --��.� �� ' €� ��: .� � � ` �� c� .�� ~�� 'G�, -�--�----� �----�-----�--.- �� a , � �'� � `� �� ; w .� . . s�� lC,� _, _�_ . ,: _ � _� ' �£ � fr� �. ��} ��,..� � �� ` ,.�� 5` `,a�`_.._. �� -- �4 ...� _F�__ �� ¢ }� � �; ; , � ; .: �. : x ,� ` '� : ; { g ` '' `.`� . , � �� . � �'��`<�E . t ; � � � � �� :; � ; : �.G� �� " ��°� ;� � � , � � �` � � � «-.��; �_ � � � ,� `` � � �i`( C}y� fE �.. ,��_ �}a � ¢R 8 . _ � � + F'._ .. . , ��. � � .. 3 y �� '3 � : , R�' �„��F � �` �� k ��'k�� ' t : S � � . . , i '' F s g t . s� �wr--.�_...�. -.... " � � . �k`_�, _ � _�.._.y>-,.�•.w.--' . � b.. ' t � � ► �� F,�� ' �� a"=;�?�. � � � �� - � � � s �4 �" � � � � ` ��.�'� �� " � � � ��..,�F��:� � �, � �� =�� d � �� i� �.� . . �� ° � � � � `�i��N� � � �. -� � � � � � �"fi � � � # ` � — � � `�a �'� �� Q �� `: � �� .� s � � ; �► � � ,� � � � �� c� �� ` i � , , �� l I � � c� Commonweaith of Massachusetts Title 5 Oificial inspection Form Subsulfiaee Sewage Disposal System Form-Not for Voluntary Assessments 95A Oid Main Street-Bam Property Addrsss Jeffrey j�Lorraine F Traub Owner pwners Name Enformati0n is gass River-South YaRnouth MA 02664 08/27/2015 required for every page. ��YR� State Zip Code Date of irupection D. System information (cont.) Sketch Of Sewage Oisposal System: Provide a view of the sewage disposal system, inciuding ties to at ieast two permanent reference landmarks or benchmarks. Locate aU weils within 100 feet. Locate wh public water supply enters the building. Check one of the boxes below: �and-sketch in the are,a below ❑ drawing attached separately � �� "`X' � �� 1�'� n� ',n �� . �5�� M' � �� ` . � �t��b�' , i � i I � � 1�-.i�� I � �° l 1�,�'� � i � , �6,Zt� , 1 _ � r ' T � � . � 1 . t � � , a i r t5ins•3Ns rab 5 OIGde�kiapedron FarrtG Subairrace$eweae DieposN Sr�em•Pape 15 ot n � i I �