HomeMy WebLinkAbout2019 June 03 - Sign Off Transmittal, Sketches - 12x16 Deck OC:YA 4„ TOWN OF YARMOUTH
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PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: .3q \ic y ciao rLC\t1--
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Proposed Improvement: Dec1L, I S /;?,:'1 t,c, -fe
Applicant:.k►'0,r v Q 1i'`'e c.::_ - f CCt 1 )0 Jo— Tel. No.: LSD 6))77147 -SOS
Address: ° Hay POOrl Lary:- )Cry r ior.1t"l yott, rt-it=r 0-2.0-75. Date Filed: 3 /
**If you would like e-mail notification of sign off please provide e-mail address:\l`t", t c6o,IA(y\l Ci-2.01 L = a 400 .c.,0 r i ,
Owner Name: ,. Crwi'c r 0 Ylet;t. "!
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Commonwealth of Massachusetts
* Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
39 Harpoon Lane Assessor's Map: 115& Parcel: 122
Property Address
Blake&Jessie Decker
Owner Owner's Name
information is
required for every Yarmouth Port MA 02675 March 16, 2012
page. City/Town State Zip Code Date of inspection
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
where public water supply enters the building. Check one of the boxes below:
® hand-sketch in the area below
E] drawing attached separately
LOCATION A B C
TANK IN N/A 29.0' 16.5'
TANK OUT 36,8' 22.5' 22,5'
DIST, BOX 21.2' 13,1' 43.5'
LEACH PIT 21.3' A24,4' 60,8'
Note' both septic tank
cover have access
W '2Poo ✓
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EXISTING 2-BR
DWELLING
GARAGE
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WOOD .
A B DECK
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WORK MUS ,NFORM TO ALL
TOWN BYL S & REGULATID
RECEIVED YARMOUT WATER DEPT DATE
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/� JUN 03 201
Mins•11110 (� c' Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 15 of 17
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HEALTH EPT
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