HomeMy WebLinkAbout2022 Sign off Transmittal - 7 Foot addition 0�-Yf.k . TOWN OF YARMOUTH
'')y - HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: 95- 1,011-cin Z6c.f) & yartyit L j a (3 11 LJ
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Proposed Improvement: '1 ç-t,cx* GAd. N il(3ri
Applicant: J Oh( 4- flAprti 30..f f Tel. No.:
a63'g1gg- 5-5—lo
Address: q kk)( -1(l 0 SC. airr{wo ) M&5S Date Filed:
**If you would like e-mail notification of sign off,please provide e-mail address: r l�t �eG� %� Q 0 YTh
Owner Name: t)D a 1- x '14 J <
Owner Address: "1.S w \ \ -\1,\ A. St -(..) ,(yK.t , HGv Owner Tel. No.sJ.63 - y g g-'4
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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^ _vu and septic system location;
(2.) Floor plan labeling ALL rooms within building
JUN 3 0 2022 (all existing and proposed) —
Note: Floor plans not required for decks, sheds, windows, roofing;
HEALTH DEPT. (3.) If necessary, Title 5 application signed by licensed installer
with fee.
REVIEWED BY: DATE:
PLEASE NOTE
COMMENTS/CONDITIONS:
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DEED REFERENCE : M :
CERT_ 195057 U r
RECORD OWNER 1 'items .p
I JOHN Sr. MARY BARRY Og► I ,
I 1 a- 8 WEDGEWOOD COURT ���°ti9"
I- NEWTOWN; CT 06470 • ; ,
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• -'' , No.39398
8 LOT 74
496 FOREST ROAD
SOUTH YARMOUTH, MA 02664
774-268-2035 �1 A / f,A�j
CERT'F7ED i OT PLAN IN lAi! lMO:Ji.' IMA f 1
i CERTIFY THAT THE BUILDING ON THIS LOT IS LOCATED AS SHOWN ABOVE ( j
AND IS LOCATED W.TH/N A HIGH FLOOD HAZARD ARA, ZONE All
COMMUNITY—PANEL NUMBER 250015 0006 C. MAP RE14SED JULY 17, 1985.
95 W1LFIN ROAD SOUTH YARWOUT r,', MA J
PROJECT: 12-00 i I SCALE: 1 JO' ! DATE: 1O,731/16 j