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HomeMy WebLinkAbout2022 Sign Off Transmittal - Deck TOWN OF YARMOUTH .:41V, ; HEALTH DEPARTMENT PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: Building Site Location: 38 Fra - iCS 46eeft Proposed Improveme : C(JY1.S�?' U ( -1 ALL (-1�,1 e3C�( vl &k b a ddx. U Applicant: Co Cls,-e_1 1c, Tel. No.: ZU 2_1 -7 25 CI`i Address: ( 2 ✓1 j2j wf63e,c4-MA Date Filed: 1 /(/1:1---- -->7; **/fyou would like e-mail notification of sign off please provide e-mail address: Owner Name: a C)1 e, > >-C. G xi S`.rtV ahp.l� Owner Address: 7 V c s e e 5 �t �c„n ° r'°Owner Tel. No.: ZC)3 Z I `J Z.,Cos__ 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; HEALTH DEPT. (3.) If necessary, Title 5 application signed by licensed installer with fee. REVIEWED BY: DATE: PL ASE NOTE COMMENTS/CONDITIONS: , l rL.•1T@D Qv RPF (3-3-83) 9M' • )! • - . 4- Lo1- • • /• . . A = 0.54Ao. • . , a.. `• . Q ' / '2�� N /_07 /.? 3sG85 ' s. tll . 59 V co�� �,� . • . B , found ' • ce'aT/F,LLD ' OLoT fit[,. — . •• • . Top .'OF FouiJD.- = 3.1. . �l+'toUTiY •f�8oV,6 HIGH .POINT /N •4 oc4T/o*j; Y . aC�il:e l '!ii 3o�• aiiTa*t' ad - At - Z , - le. 04.0 - . - : 6a/NG •.GOT /? Z el-,.. Bk :i . . 3 - 7 .)- PG. 25 . .. t i�ateot%.caa r•IsY rNgT rs�e 6V� - -` =. -- -ro....." \ - .as.raww:a i rNia ."tome. ia• .coC.vrfa - Ttve • _• '• •Ria -_ Qao&.,va 'mss .� ow.✓ N,rseav' .awa .rN -r sr• . • to , f"""`l pa6.s• ‘4,01.411,04C4.1 rp. 7 so . - � - . 1 7 5 .4r.6.Lga Ow .rsvai .maw ow Ys9ie/ o -fN . . .• '• . •• • ' : , i✓Naw cavarwcr0a: . • • / / • • •- ..;,-,i,t • • . . 'G.. 'O.. lit:/• • !d /& L'L•a•,e , avc • ' I • • - • . ... • . OATS •....••• - - - - - - axis-71-1/-7g ground pro ile ' ., Hoe, . SCALE-: /".. /o,' -.-o—ii----o- proposed ground pro lie ( L 0-/- 2 )., • Cz_,-,i- 73. ) . Ai \ _ ------ 'N . --"1--- Girg'Fi i \\ \ 1 / \\ \ / 0 1... 0, / , I .,-.) 0 '' '' AS. • A ei i 01 . (3,1-. 'As • \ ‘ Xl . l',,, l • GO 0 ' 1 7 ' ' .., .•,.0 k\\ . I Cr' - t\--- ).4 :,!;t • I \ C\ „..i C\1 ' :+•• t‘ - • \ ------..... . \ , A / , ' ` .1......0.............. 113 \ 1 —V`• ' / a iik . ct , ( , .. .......„.----- ' 4 d. ._ . . . 0 . . -.4... ti) ...._ : .. ,÷ , 1 5i3 - -- • ---.. t ----- ....... ,-,• . - --- :- - ' -- ----- ' ------ N- 11 .;Vr:i' ' --- ' c2r-” -., Acl• / -, k-.12) vi - IC /- 1-----0` ' : -- 0,;.. --', ,:k • \,, ! ,/ .c. • ' 0°-, ' / QT IC? ••< ' .-rri, : .„, \,. ,,..,-- 23) C,8 5 5.f Z.. ! \ .. ,.- , . i• .., •• S, -.5 . 1 .s \-- •-___ ___ -.\----- ... 7.q c i A S. ' 2 - * -.• 0 -'e' f. 51 • \. . ..:------- .....)?..6-,'9_,•• --r" / i•-/ ' id 5 ' Town of Yarmouth Subsurface Sewage Disposal System As-Built Information Street Address: 3 8 bra ccs ��-�lea !2A Map:/ZS Parcel: 3 Owner Name: L�z fkaz- of b Permit#: c1 ,Zi - L1Dti8 Date Installed: - - 1 1 — New: X Repair: Installer Name: lie uLi . O OS< Co • Installer Phone:� /77-g8 7 Installation of(list all components, both newly installed and existing to remain in use): la-40A vk ,3 -, g 4i c % &J./ R/iii. /Ha) /o,tl./L ` 4G/r1,.J cpw e Leach Capacity(gpd): ''"*".— Ground Water Depth (inches): Health Inspection by: 756-''( As-built Diagram (Print Clearly in Black/Blue Ink and Use Straight Edge—Label Risers and Zabel Filter) ill (f12-Ohl. O 0 2 3 A B C I -- D E F G 1 3(aI ZION — 2 5Z ' 36 ' 3 (��{ 3 2, ` 4 5 6 — _