HomeMy WebLinkAbout2015 Sign off Transmital - Slab Addition TOWN OF YARMOUTH
0IC HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
�Ner
To be completed by Applicant:
Building Site Location: I c 1)•..
Proposed Improvement: A-as , • i o s` t J o i`-1G 5 ti o + Cl n heats)
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Applicant: ?6,-\-er (o cc, I Tel. No.: -737- 1 ZriS
Address: w►ro (5 C ?d Date Filed: 7-
**Ifyou would like e-mail notification of sign off please provide e-mail address: ,z ti 140,_ 1 pV L%65y, L
Owner Name: r '4 I IL .+1 cam-�9
Owner Address: 5cx-,/ 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: 71/ e//
PLEASE NOTE
COMMENTS/CONDITIONS:
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PLOTPLAN 09-188 (AKA 08-285)
PREPARED EXCLUSIVELY FOR THE PURPOSE OF OBTAINING A BUILDING PERMIT, NOT FOR ANY OTHER USE
LOCATION : 84 HOMERS DOCK ROAD,YARMOUTH PORT
SCALE : 1" = 30' DATE : MAY 8, 2015 PREPARED FOR:
REFERENCE : MAP 149 PARCEL 85 PETER 5_.:.A:4 I : ALL
REGISTRY REFeivE0
agigEuyEDSEP 7!115 SEP 7 o t ,
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:550088-2-4541
HEALTH DEPT. TN,, Ctso,
M®Ur
down cape engineering, inc.
CIVIL ENGINEERS
LAND SURVEYORS
939 Main Street — YARMOUTHPORT, MASS DATE REG. LAND SURVEYOR
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KRY GORDON ARCHITECTURAL DE51GN I Kit
NAAng(--qg cnp.--7c)n- i �.4r-1 84
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Dock Rd.,Yarmouth
PROPOS. SOUTH ELEV
991A@1ROWIND
SEP 2 8 2015
HEALTH DEPT.
REV.:
rev. date:
4
SEP 1, 5 2015
TH
6-2-15
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