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Application for a Permit to Build
Fee must accompany this appli tion
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Yarmouth �J 19�
TO THE BOARD OF SELECTMEN
The undersigned hereby applies for a permit to}build, according to the following specifications:
1. Name of Owner�s Or1 T $' 1-1 Lb T' t c I,I Address 43 A L G4 1%.)`"i>11` C), 1/(4
2. Name of Architect (if any)
3. Name of Builder SfsAy
4. Precinct No. .7 Lot No. eW£7 Plan: Name or No. 4 At 3G, /Q-7
5. Name of Street /� 3 `-Z `-ckl �GLi
6. Purpose of Building C LQ S e.D J_o J$ f 21 /
7. Material J,` cf
t
8. Estimated cost of building 1/35 o d 7A(C y X2-1
9. Dwelling GL�$ar /F/ �ORce7
C7 o /Meet-(
10. Cottage •
11. Heat '11 Cal OP
12. Basement SA ONE
13. Garage .
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14. Store
15. Shop
16. No. of stories
17. Is there to be a Store in the lower storey .. _
18. Size of Lot. No. of feet front I ti4 No. of feet rear ....L.a Q No. of feet deep 3d '
19. Size of building. No. of feet front 3 aA... No. of feet side No. of feet rear
20. Distance from nearest building: Front t) ft.; side' ANSI ft.; side 34U 3 ft.; rear..L.Q1�........
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21. Distance back from line or street ttr , from rear lot line .00 , side line fs
Show-byediagram the location of propsed building with relation to d• tans s from adjoining lot , op reverse side.
• Name 1,r ,�p
Address. 1l N 3 `Y LLLC Z.o
Sheet Name ..1\.P.iv...14
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O Left Side Depth of Lot..........�.. .�
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5,12 Zi 0 rg
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Right Side Depth of Lot .
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PLICANT: ' '' - .'1- it R I S - • • • BLDG PERMIT NO
CATION OF 'PROPERTY: �• t tv i[;La W -- _S-s't=j-. - -• ?: BATE.FILED: _: • - •
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THE FOLLOWING CHECK-OFF SHEET IS DESIGNED TO CLARIFY THE PROCEDURES AN'ZNDIQIDUAL.- r,;
1ST FOLLOW IN' ORDER TO OBTAIN,AA PERMIT TO BUILD OR ALTER A•.BUILDING. "-THE BUILDING:••••:3-•:„.:-:,),:i? ,
PARTMENT"WILL'CHECK ON :THEt FOLLOWING:- (A); • CONSERVANCY DISTRICTS, (B)::i HISTORICAL'=• -
STRICTS ' (Cris-FLOOD PLAINS-'ZONING," AND WILL BE RESPONSIBLE FOR. ASSISTING THE:= - ':•-' .•,''"
PCI CANT THROUGH THE FOLLOWING AGENCIES:..- /....:"Z...";...--t.- - - --'= ," `'--' •- "�-"-%'' '
•2.-:",r4"--% 'r-•_{ :_
• RES70ENTIAL BUILD- ING: _ = • - -.-'
-
A) CHECK WITH THE HEALTHDEPARTMENY IN REFERENCE TO SEPTIC SYSTEMS F04,SEWAGE : ,
"
• _ •- DISPOSAL ` :-a•- _ +.. _ _: . _ - 3.. '(7 ii ' .:-_ _--: :: r
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CH
B) CHECK WITH. CONSERVATIONCOMMITTEE IF THE' LOT BORDERS+ON ANY TYPE. OF WETLANDS. -1_
- EXAMPLES:, STREAMS, PONDS, RIVERS::OCEAN; BAY, BOGS, MARSH,_ ETC. r',:.-.--:- ` ' '
C) CHECK•WITHiPLANNING BOARD-FOR•lOT _RELEASE ="(;;T: - _ _i `;i- __ :;
?:*.:7".....::-.Z.:::; -:-:.--.:--� _-m.7.. - -_ - _ - - :- 'c;'-' .. _ _ .__• '_ .--`;.:
:} '.I',�-��-::i�.� -��.t� �-'F't: - Jt-••-•:::,!::•55....::-:,:::i:•::::3 _.may.-
4`_. •l _ tiJ4`-•::: -i- 0.i
COMMERCIAL"BUILDING: ::�= ;_r a,; _ ; - . z:":1;2.: 1,7 :- 'T.7--.14;:t:‘• r' :Cif c-
~'A) . ENGINEERING D• EPARTMENT-FOR-PARKING AND DRAINAGE REQUIREMENTS,, TOPOG PHY SITE
LA :
PN REVIEW:'-- = t-- ;
. ':' ^ -,._ :L=' �= - ,t _ - ,:._ -
-_� .� _ .i �-'�•: .•=l :moi}� --.:.. .- '..:. : . ... .. > - •: _ ( +.
.B),:. CONSERVATION COMMITTEE-IF LOT BORDERS_ANY TYPE OF WETLANDS.::'-, 771":-•:.-•:;•.-- _ -
C) .. PLANNING BOARD-TO :SEEIF LOT COMPLIES WITH ZONING BY-LANS. •- - - '
D) BOARD OF. HEALTH'-FOR SEWAGE DISPOSAL REQUIREMENTS, HEALTH RELATED ACTIVITIES. ..
EXAMPLES: ' SAUNA''BATHS, SWIMMING POOLS, RESTAURANTS, ETC. : . , _ • - `^ - •••.- •
_
"E) FIRE DEPARTMENT-FOR PROPERTY PROTECTION, PERSONAL SAFETY, (SPRINKLERS, SMOKE'--5 '', .
DETECTORS). . .:. : . t..•
'n: t ..ir-: - • ...::,...."7:` ...:::-::::•=:1....:_ .^-'-_ :--_ .• ,f'_ - < , r=3:�:niED :B
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E• NGIN ING DEPARTMENT: = YES ' OEiz-
S NOT APPLY- GNATURE .,17 �-; = -;i;, = OAT i:,
CONSERVAT30N 'COMM- ITTEE: r.YES' _DOES NOT 'APPLY' ' SIGNATUREj�J.,, ,_ = DATESJ(¢ • ;i'
PLANNING_ BOARD: 1••Y ER 't' DOES NOT"APPLY_' S•IGNATURE:=`': •�:'•`' ':% *DATE"=- •=_
13.-0A OF OF HEALTH: ' YES'-if--.66E NOT APPLY ' SIGNATURE• .b' •' 'ac:;•;��' DATE-5-3
FIRE DEPARTMENT:, • . . - • YES DOES, NOT APPLY_SIGNATURE - t - • - DATE1%44: - ".'
NTS: - - - ▪ _
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