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HomeMy WebLinkAbout2022 Sign off Transmittal - Adding bathroom & Deck S r ON ink TOWN OF YARMOUTH s, ...t. ;.5 A ° HEALTH DEPARTMENT PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To he completed by Applicant: Building Site Location: /'7( 071%4, Cl. / l �' ' )720(J)1 far p:4- ca 2 6 1"-5 L., r iv Proposed Improvement: IT. Lt/c, �;j 7',.2 (, ,i,_, c. c.% }',�lh ,; ;� �7 /,4- /?_;= ' ' ./ • L i re c n1 7 7 !5 )1.t' kr hdl/ Y c).a », /L. 5 IA, 7,7 i .e_ [s G 7./fr `2 O" 7 Ji )l� 5,14;k- f-,,,„ l/?4' ( C 71-,7/(I/ r ci J" ? ,-/,)4C)t.d 1 e f ! a .-, /h.e 4 Y.,,,,/ „v,. -7---,?7,-1., Ti 3iJ clri o7I>r ✓—r ' -"+ 15V4c- -,b(:--CIC I J, I4-/` Appicant: ,1r�.cr:/ ( 'c,i f- Tel. No.: l?r c� 4, i1 -3/ Address: / �r ( ,m �,. VI r ,. /)v 177'94/ / t?3 "fel c%2G �..-t_ Date Filed: **Ifyou would like e-mail notification of sign off please provide e-mail address: Owner Name: Rt..)(/ /-. `�'�r 5 f h Owner Address: i a �i1,.., `> � %�;Y 7);L)v /h O Owner Tel. No.:(75 l) I? . P-3/ 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: 1V��/\-- 4-k- /� DATE: . r ) ') "- PLEASE NOTE COMMENTS/CONDITIONS: L ��(1 t .� H /r-- c fy-c='c ( ; / .5 (-- c.`/ -) �v (' .",,; /": 4. s I c-1 /: ' 4t- \-1 40 f,,\A, 1-- k,0 ,,( / i)) c t D c (< I :4, 1 y 1 41 IP' , F - - - - - ,-- , . --› „i____ T J / 1Ye;` J A '',(7 ZVci v V , /z N /0 -PQc/ , ao 3 6 X lz p u li I ,I, - ie. \IV Ii.' T i, por V l'- , I L, NFQ�d ; ''0 \''' r APR 0 1 2022 I' HEALTH DEPT << AA tic! govt fi o 4619(4'5/ -P-' „4-c(clf v,P s 5 : /?- 04/; 117 5</et v- ,9(irk 147 v( �g" 0 z4 7- .7 3•S \ V 1 o o d Na l g. o W ; 4 S �\ 4 s /j/ /✓v+^i 47 d 7-11 r gil a ,rr o Jar" , I 1\ ,t„ I / 1------, Atli( kir ,y _7 ,4- 44 J /4/vcl I 00 4r1 : V F Zo-o � Commonwealth of Massachusetts Title 5 Official Inspection Form ohlet.,04>n.4.\ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments • . 176 Union St Property Address John and Theresa Williams Owner Owner's Name Information Is required for every Yarmouth PortMA 02675 03/10/2020 Cite State Zip Code Date of Inspection D. System Information (cont.) 14. 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 ❑ drawing attached separately n Ili I B A 1111A vv�v © © 30'7" 25'6" - © 60'9" 18' 111111 ©- 74' 50'6" t5inep.00c•rev.7/28/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Pape 18 of 18 IF / a , iillinqm � S® �0 57r ai.a-,! : - ill gran -§.3m p-0 I M11111111111110 "i&! o5•- o cs2 s, o ADZ Isom9. p 1 v >4 g O Y Qi- ,i o_m000 �: - • o AaNa0 Fy \ ', a�g n o 4y i E- \• nn » � - or ml Y •>'') IF4 U Oh • • 90 it 21" 1 i .. 0 3 pp JA / olifik __—::. _ -=__.-_— • 73 NS, ‘IStoNtti . . _ _ ,"... ,4.'4.144. =.-111, "fi 4tft _I--_,t-f , :Iv. , 44 i0 -^A- --- -4)14 \Z - ,\ E oc 1 \\ 4.\ r � i Y 1 -1 0 ; 11 1'9] .#„. ,,,. ... ,, ., 3 11 11 I aiI jI 43 is �• PI, �: a � N %T"'`ti.. IllItIP1W : " 1iyq 8 •p;,u1111,111 ' V P� _+�_ �� , . 7. o 40 =o nil diliill -t go -Ro `� q 1 w 1 2 —1 . A tc Egix g c gl a ] ii:124 1 1 1 li i y a w O A ^� o 8 rn n in Cl. A \ _ .va w "' g COo m Z XU) ti v Q U Ovs 3 1