HomeMy WebLinkAbout2022 Sign off Transmittal - Deck �,c .-y..:1 TOWN OF YARMOUTH
4, HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
• To he completed by Applicant:
Building Site Location: C J d M ' v
Proposed Improvement: 1 -Q rti Q \I P t'c:i\ m '0,, jAisr\--.::r\`\\ \ ' I c' I/ -.\C
Applicant: 0 0 7/ Cwt -P (1 -\„ CC lu ���
1k , :12C Tel. No.S'og -'1-73r1 5' 3)
Address: P- 0 '7 X Li IDate Filed: Ii i Z 2
**/fyou would like e-mail notification of sign off please provide e-mail address: S.--.G u S e c2-5C E,} i \�A,. , ( 0✓`1
Owner Name: A l '� ) c w e 0,. (-
Owner Address: ZZ ) um- 10, -S k 0,,, I--e c (xic_?i Owner Tel. No.: 33 7 227 -Z3_30—
RESIDENTIAL
Z33.-
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,
___l;�_ and septic system location;
MAY 1 1 2022 (2.) Floor plan labeling ALL rooms within building
(all existing and proposed) —
HEALTH DEPT. Note: Floor plans not required for decks, sheds, windows, roofing;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
rm
REVIEWED BY:
1
DATE: c"'.16 �'�
PLEASE NOTE
COMMENTS/CONDITIONS: //
I)G ,/).c r r (�c,e �j c..11,-N. `�.4-e ov-e✓ S'r_4J�/ c-. e
_.
o
-
gd u.
• iq8'g e he: 4 e ,4� i"arp g>g hs§ Q W 4 ' va g b.< °.- 'Vita AA gag v; pia 0, ., E- . ri 3 - +I 0 A § 11 5 1ii;;
�. a7a=hs5g to : Rg .:rsp §X lot o 022 ace —
.
..
,. E5,0-
(A¢11,..5.� W 8 3 N . V to;.,Fp 9.k,.Ai-.@ 2 rig-tixl ->. .g,t,' te% gi i0. ..o ."'1 ...FFA 8' ;
� e g j'. §,g o dW k t36 3Zro Vt gao. $ 4 d - o to �o' ,Z
:co, W 17. < V "ii g`" -X 4a✓¢ ;gli_-4 A'- 8 R'zn< _- .<( - h i W
<m. Kb oitf-AiS.'t.-6oiul ,_ < .ai!o:'1etffd:�`oGam[,,,: .k9 3 .�i. ill
h s "'`.1::14 21 § t o llg z 050. IY_t
4 a^ $. ` / : VG.g§b8L3`2• .oV X's4#..g �NsR�;§%iiil`#.lige •
_
z\
I
U
..: h CV ` V % NAPM MANN } .1- M 3
N LIQl �.:_� ' :� r
= ' -
III '41.011 tea t
e` I x"01 ii to I o .5
tl _� � � T illi; =a
q ► . EIS 2i••if s
vi 1
3 omr e. u u
\ .
� O
te , . 3 . �
•
glybi ,���'I •a"., / . A...„,.„:...,,N,,,,\\:: 4° - x
on NI\
kit
9k 1�_7ji1j:i
oo / /F IC 1 �6 s&o;
•
i t41
ZY oz. \ iP
. .....,
4-4 LL 3�� �
o ,j W I R, s. .-, F o
o" p\JS /4""4,,,...,-- g
ea
n
us
J .....ty_ 2.14181145 I
ma \- :1.*i 12
pz w�
a< F 3
10
bi -'g f�
Bl:o 9L etied.we sAs lesodsla a6emas anelmsans wad uoipedeul re!o'AO 9 elnl
910Z/9Z/L-'VW•oOD'OSIpC
r -21 I L--$'E
•
9 s-2 g-g2
o- 2/ 2--._,s2 z - ld�a Hl
2- 0/ 9-zc ``r--; �b�H
IS 1 ZZOZ L i AVW
)(
0
'',\\) \
el .•.0
--/j '..--il\\\s\\).- ° • . .
' I
lea
c- I
Ala;8Jedas payoem 6u!meip C]
Moleq eeie eq;ul yo;ails-oust;
wawa�tlddns Ja;enn ollgnd aJaynn a;eoo� ;aa :Mo aq saxoq eq;;o auo�loaUO •6ulplmq ay;
90U8
wawa }006 u!yt!M sllaM He a;eooil •s�pewgoueq Jo s)pewpuel
nn;;seal;e o;sag 6ulpnlow 'wa;sAs lesodsip e6eMas ay;Jo Maln e apinoad
:we;sAS lesodsla e8emas jo tiolaNS 176
(1uoo) uor;ew.iojuI we sig •Q
uoiloedsui;o also epo3 dIZ emsumollig_
6ed
6 Z/9Z/L b99Z0 yW y;no A S tiena Jo;pai nbei
si uolieuuo;ui
eweN selauMQ Jew°
ggel Apnr'8 6wple!d
ssalpp 'IclJadaad
yW 'y;nowJeA .S deM aa;ueys-0-wel 9Z �,y''kt,
= —=
`)s;uawssess tie n!o Jo;;oN- wJod we;sits lesodsl0 +Ames aoepnsgns "
uLIod uo•R
oadsui !e!o!liO 5 aa!1 '__ ,_ill
s esng3essew!o 4HeeMuowwo3
; ;ti Commonwealth of Massachusetts
1,-..i-----4--='77-.±-7.._ (0 Title 5 Official Inspection Form
, _ ___ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
-=ilii=i,
N ' 25 Tam-O-Shanter Way S. Yarmouth, MA
Property Address
Fielding &Judy Tabb
Owner Owner's Name —information ation is S. Yarmouth
required for every _ MA 02664 7/26/21 _
page. City/Town 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
I �et
:4 i c
( i
-
It
\:,.....t:_i_____y_ 1-' .
•
ti) O
()/
iv eM1 Rm o a �C
0 3—I I 0 J \ ')(\\"'
> .` �I �c\c
Li
MAT, i l 2.027
HEALTH DEPT I -- - B
;
� 3L-E lv Zi
2 Zs'--z /g ,0
J
28,8 - 6 i
35- 7 I i$- !
•
'5inso.aoe•rev.7/26120/8 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 16 of 18