HomeMy WebLinkAbout2019 Aug 13 - Sign Off Transmittal, Plan, Info - 5x10 Covered Front Porch t-yta
ot_'Yak TOWN OF YARMOUTH
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t�° HEALTH DEPARTMENT
�y":'' `-- x PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: 5 `i L 1 i f'c_t1-' ,.c L„-f,
Proposed Improvement: - '7( /0 ( ,';"--''11",il A o T `
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Applicant: j�f -e, Yr p1 14 CAI 4 yi Tel. No.:
Address: 5 t ( (A r Z- (( 6} j z') t 1 Date Filed: , 1! 1:5
**lfyou would like e-mail notification ofsign off please provide e-mail address:
Owner Name: ,?l" ji /1I v-Aka__
Owner Address: G C (-4' i r (r(_ /_a Owner Tel.No.: - )- ) 21.-- /),)(-
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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 location;
(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: ( i )
PLEASE NOTE
COMMENTS/CONDITIONS:��jj_
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- RECEIVED
C HI C ICADAUG 13 2019
HEALTH DEPT.
RES. ZONE. "R-40" This MORTGAGE INSPECTION Plan is For FLOOD ZONE: "C"
Bank Use Only
-TOWN: eft Y.411010117-L___ _ REGISTRY OWNER: ROBERT D. & JOAN F GONSALV, 'S +
DEED REF: J695/265 _BUYER: . 'TES C. WAZE'RMAN & KARBN_Af. MCNEIL _
DATE: 21, — —5_ PLAN REF: _256777 _ _ SCALE:1"= 30' FT.
I HEREBY CERTIFY TO BQSTO _EED� __S3._IN.SS..BAS
THAT THE BUILDINGZHOi �� YANKEE SURVEY
SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS V" CONSULTANTS
SHOWN AND THAT ITS POSITION DOES _ __ CONFORM ;. S PAULA. 40B (SUITE 1
TO THE ZONING LAW SETBACK REQUIREMENTS OF THE MERITHEW
TOWN OF ___, '.a&11QUIH AND THAT d No.32098 ' INDUSTRY ROAD
IT DOES NOT LIE WITHIN THE SPECIAL FLOOD HAZARD ,, `� ; ARSTONS MILLS, MA. 02648
&REA AS SHOWN ON THE H.U.D. MAP DATED Ct_7�¢¢ _ '9b� sti�P� TEL: 428-0055
Co unity-Pa el # 250015 0003 C L. lgry. - dz. . FAX: 420-5553
_z�i...w`�9::T. 1.1,1.1.12.,,__. _ TI•IIS PLAN OT MADE FRO •'_:=�i ENT
k, AUL A. MERITHEW, PSURVEY, NOT TO 13E USED FOR ' ICES, ETC 17231 DPG
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SUBSURFACE 8SWAGE DISPPART OSAL
SYSTEM I1(SPECTION FORMSYSTEM INFORMATIOI4 continued
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100'
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�.. RECEIVED
AUG 13 2019
CHEALTH DEPT.
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