2022 Sign off Transmittal - Repace Deck TOWN OF YARMOUTH
o HEALTH DEPARTMENT
'4co`°.' PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: 5,31E c.n
Proposed Improvement: '�1eD Klee_ G 2cs�` �ctc� c�'P VC . ��q a ctrA
re lace, cona� - vto�-ac
Applicant: Ca\G Z7cLcobS Tel. No.: -7 353—(v$5-
Address: F. 0. 6 ox 3`1`'( Yacl W UlfAPo -3 (lW- Oa-67 7f Date Filed: (v 6 9/W�L
**If you would like e-mail notification of sign off,please provide e-mail address: \0.CA VC 78 o o0 CortA.
Owner Name: C,(,,Q�p P r 1 e(p V
Owner Address: s3 -D:CWIt. Owner Tel. No.:B(o - 80- 76 70
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:
AVENUE
GRA�ON A=39.2 i.
N 7915'20" E 75.06 "?`?
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\oEc4cMAP 79 ■� c m
PCL. 55 SEPTIC I co Z
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(0.24± AC.)
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S 79.15'20" `N 100.00,
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I PCL. 75
MAP 79 I �) N 2 9 2022
PCL. 56
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HEALTH DEPT.
THE SEPTIC SYSTEM SHOWN IS AN
APPROXIMATE LOCATION BASED ON
BOARD OF HEALTH RECORDS.
CERTIFIED PLOT PLAN
LOCUS : 53 DIANE AVENUE
SOUTH YARMOUTH, MA
REF : PLAN BOOK 122 PAGE 15oF, S
PLAN PREPARED FOR /rte JOHN c%,
CALEB & SABREENA McCOY DEMAREST,JR. N
4 No, 35659„
SCALE : 1"=30' DATE : 6/29/2022A
29 2022 / 'it,
-
R
Iii.'. p.il� .,
ASSESSORS MAP: 79 PARCEL : 76 DATE R' . • URV. OR
I HEREBY CERTIFY THAT THE STRUCTURE DEMAREST LAND SUR ~ NG
SHOWN ON THIS PLAN IS LOCATED ON THE
GROUND AS SHOWN HEREON. 338 MAYFAIR ROAD
SOUTH DENNIS, MA
508-364-9049
FILE=22060.DWG