HomeMy WebLinkAbout2022 Sign off Transmittal - Convert Coverd Porch to a 3 Seanson room ot-Y', '� TOWN OF YARMOUTH
;•,41HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
- To he completed by Applicant:
Building Site Location: 2 q up tins&tom cvil-p' Doi LQ' ` eka..P-tOurt-14 AAA 02_6`1
Proposed Improvement Jo_ r►V�>f- r�)fs c�c� n c S l� /��c"�b7 f tl O 1-t°e S�cr SC�t'►
Applicant:�E k',-O - Pe re Z Tel. Na: ZCr 3 °f O 0 301
Address: Z67 ub ti't SLd ce) f 7- td. cu. yogi))0 014 Hck D2-6,`) 3 Date Filed:0--(-63 202 a
**/fyou would like e-mail notification of sign off please provide e-mail address:
Owner Name: 14 eakJc-) Sr(YiCk - r- Z
Owner Address: Se1-1E As t>P,O1/C Owner Tel. No.:7Q `ice -03611
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: ) ��
PLEASE NOTE
COMMENTS/CONDITIONS:
MAP NO. mAp 48CcEEI� 44
LOT NO. : 298&299 ADDRESS :269 WINSLOW GRAY ROAD, WEST Y
OWNERS NAME : Arthur Ka I fopu l os
SEWAGE PERMIT NO. :03'13 NEW: REPAIR: X(
DATE ISSUED : 1 /10/03 DATE INSTALLED : —2,47-63
INSTALLERS NAME : e013 A ro ltrS conS
INSTALLATION OF: 6,5 .E it`X 3? X /d' Fc&I)
WATER TABLE : 1 ao' FINAL INSPECTION BY : /11/'W
DRAWING OF INSTALLATION ON REVERSE SIDE :
tut osc-ow 6+ K �d •2,6i
117
.
a-1
4-3 - s411
1
sd,?
-� .- is.'
Iv
r3-3 S
a 13- 3Y,5tIcte yocazx
96,6
El 9
BASIN '< •' ``s z \ I% :98.3 f'J
C. BAZI
S/N l2 .
;.
`aJ \ 96J �X
\ �\` 9 6.
96
L- LOCATION MAP.
1,
APR U 4 2022
HEALTH DEPT.