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HomeMy WebLinkAbout2022 Sig off Transmittal - Replace land with deck 4ittA.ir: .,�t"Y;'� TOWN OF YARMOUTH HEALTH DEPARTMENT PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To he completed by Applicant: Building Site Location: 1/ 1 'VI k1/6/14A-<1-C- w G, a 'YV G., Proposed Improvement: ;A / Z I i ' mg. /o --y/c:. •- L c j Applicant: 0-4W/ nA(14/C/1 Tel. No.5 ) 5-73 7( -3 Li Address: 17 (cYG le--Or\vt / - ft )4( 04--- Date Filed: C' /7-•` a-)m, **/fyou would like e-mail notification of sign off please provide e-mail address: Owner Name: /hr ry 144a Owner Address: / 7 fl4 - Owner Tel. No.: 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: 66.45' 0 in EX. RET.WALL °` '00, ^) C) z ^o D _-- ■iii o EX. > o DWE_LING D V 3ii D N �� ±H. 11, M � =16 23.26, 6 PROPOSED DECK & STAIRS ie 61; \ SEPTIC FROM ASBUILT UN 2 7 2022 ON FILE AT THE TOWN OCC . HEALTH DEPARTMENT HEALTH DEPT. BUILDER TO CONFIRM SITE PLAN MBLU 66-46 q/____ __._. 47 McNAMARA aVE I CERTIFY THAT THE IMPROVEMENTS SHOWN ti YARMOUTH, MA HAVE BEEN LOCATED BY A FIELD SURVEY. a* oee DATE: 3-22-2022DRAWN: RBS cc, SYKES I JOB #: S682 No. 5418 N SCALE: 1"=30' DWG. CPP o,�'PF 'o EASTBOUND -13 o gree Zilw Fss/c/S17 TENO`'�� LAND SURVEYING, INC. 3-22-2022 �j� P.O. BOX 442 will FORESTDALE, MA 02644 ROBB SYKES, P.LS. DATE 508-477-4511