HomeMy WebLinkAbout2022 Sign off Transmittal - 1/2 bath in shed Yak TOWN OF YARMOUTH
s HEALTH DEPARTMENT
a • PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: Ca \ 'Y04- v\i)
Proposed Improvement: 0- (1.C!^ � 7\'\O (� S
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Applicant: Q r\ 2, (-{,M 0,10\ Tel. No.: rp 7 g Q 3 Z•S71
Address: C Q ARA- l \\i .N-c Q r-mo,A, Date Filed:
**If you would like e-mail notification of sign off,please provide e-mail address:
Owner Name: -0 1�Q R
Owner Address: ` C(.&�� �*�1 i J`nti�`n owner Tel. No.: C, -7 Al c71
• 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:
RECEIVED (1.) Site Plan showing existing buildings,water line location,
and septic system location;
(2.) Floor plan labeling ALL rooms within building
HEALTH DEPT. (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: SitkowAllifind DATE: Cr
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Cape Cod Septic Services Inc. Proposal
350 Route 28
W. Yarmouth MA 02673 Date
11/05/2021
Billing Address Service Address
JOE KEREMIAN JOE KEREMIAN
29 WOODPARK CIRCLE 9 CADET LN
LEXINGTON,MA 02421 W YARMOUTH,MA 02673
617-803-2571
P.O. No. Terms
Due on receipt
Description Total
Cape Cod Septic Services Inc.is pleased to submit our quote for the following small repair to the existing septic 1,500.00
system at the above mentioned property:
Dig-Safe to identify underground utilities.
Apply and pay for Town of Yarmouth repair permit.
Machine to dig trench from shed to septic tank.
Connect toilet in shed to existing septic system
Backfill trench area with onsite materials
NOTE:
*Cape Cod Septic Services Inc.is fully Licensed and Insured
*All work will be done in a workman like manner,and specifically limited in scope to the project described.
*Any damage to unmarked utilities,driveways,and/or irrigation systems are the responsibility of the homeowner.
Payment Terms:Due Upon Completion
R E IP7:
HEALTH DEPT.
An interest charge of 1.5%per month(18%per annum wit be charged on ail invoices over 30 days.If any invoice remains unpaid for more then sixty(60)
days and is referred to Legal Counsel for collection;then,in addition to the unpaid biting and accrued service charges,the above signed further agrees to Tota' 81,500.00
be responsible for all costs of collection,including all legal fees incurred by Cape Cod Septic Services Inc.
Phone# Fax#
Accepted By:
508-775-2825 508-775-0424