HomeMy WebLinkAbout2022 Sign off Transmittal - Remove and Replace Shed TOWN OF YARMOUTH
;.-41 FdHEALTH DEPARTMENT
'.a_G. „ PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: 2. 5 .S‘bE., LVE.
Proposed Improvement: g.ektt V �� 4 _ . `.,t ;O. _ <
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Applicant: .`" C-S411.42.1•12, 4<L (4 Tel.No.: C;PS 2AC 4-2
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Address: 7 t II T t - Vv * � Date F'iled:Z 12.S�ZZ.
**If you would like e-mail notification of sign off,please provide e-mail address: t�Kt.-U _ALL �j . L.
Owner Name: 1< Q..LIGN4L-1-0P44
Owner Address: I 52, 6( 130--AJGO Owner Tel.No.:9,0330-0111
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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;
RECEIVED (2.) Floor plan labeling ALL rooms within building
FEB 2 3 2027 (all existing and proposed) —
Note:Floor plans not required for decks,sheds,windows,roofing;
HEALTH DEPT (3.) If necessary,Title 5 application signed by licensed installer
with fee.
REVIEWED BY: DATE: .0)-`/ D'
PLEASE NOTE
COMMENTS/CONDITIONS:
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EXISTING
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FENCE ALONG Q
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�i. _,i ''\ EXISTING (_) N
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"{'� ""Yy, .�'� '�� EXISTING N
0):i -14...- 7,1:1->
. Za f STOCKADE
4 ry% �y ; \ FENCE ALONG * O
Q � PROPOSED PROPERTY - N
i'�R 511ED LINE In N
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ANO RECEIVED
FEB 2 2022
HEALTH DEP?,
BUILDING LOCATION PLAN
PREPARED FOR
2 SHORE SIDE DR., SOUTH YARMOUTH, MA
ioOFFOR
STEVEN MARK * ANDREA QUINLIVAN
RUMBA aI"= 20' 05-26-2021 TMW
No.3579i mM.m "crnrn nen.
CPP-I
WELLER $ ASSOCIATES
P.O. 6OX 417 CENTERVILLE, MA
1 TEL; (508)328.4692
EMAIL:tri5wellerlgmaII.eom
REGISTERED LAND SURVEYORS 4 ENVIRONMENTAL CONSULTANTS
!raven I%
87/21/2818 B8:51 5888422228 QUINLIVAN PAGt 16
Commonwealth of Massachusetts
--' -_ti Title 6 Official Inspection Form
-- - Subsurface Sewage Disposal System Forth-Not for Voluntary Assessments
2 sitoreside Orme
Proper Address
Kenneth Doyle
Owner Owner's Name
IMoresratd oforn ie South Yarmouth MA 0208 _ 06!05110
wort Palre. C�frown State
wort Zip Code Date of Inspection
ary
.
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including to
to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet.
Locate where public water supply enters the building.
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