HomeMy WebLinkAbout2022 Sign off Transmittal - 1/2 Bath in Front office / Remove wall to open office space ovYAte, . TOWN OF YARMOUTH
c HEALTH DEPARTMENT
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PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant: I AUG 3 0 2022
Building Site Location: Li i I Pt-. a h l St lit. 0A
Proposed Improvement: 60-+ cL `1Z betlIN iI1 cm(CA- rICAL¢_ a.rea. etc-Mo wale, -fo
oven vP o a.reo$.
Applicant: Pa. - . i t.c€lPS' Tel. No.: 77q 3S-3-6,SSa
Address: P 0. BOx 34`( Ya.riMou Por'F-, 644 0d-fn7S Date Filed: S f (Do.a..3_
**If you would like e-mail notification of sign off,please provide e-mail address:
Owner Name: E�i'IC -e_v A 1 6-p/
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Owner Address: 1 ? Al.S !0 l S 1 . Owner Tel. No.:"i?9 -_:31222_,_02)D
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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,
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.
-41111
REVIEWED BY: DATE: L
PLEASE NOTE
COMMENTS/CONDITIONS:
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Done 2 of 2
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ROOM
12'5" x 11'3" u)
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ROOM
13'2" x 21'10"
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j ROOM
12'5" x 14'0/
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Done 1 of 2
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ROOM
_ 15'7" x 16'4"
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20'9"x 11'6"
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Commonwealth of Massachusetts 1\ 7 --1
. Title 5 Official Inspection Form ' AUG 3 0 2022 I
:_ 'V;; subsurface Sewage Disposal System -Not for Votary Assessments
HEALTH GE.G
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Property Address
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Owner Owner%Name
information is
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required for every
City/Town Stale Zip Code Dale Inspection
D. System Information (cont.)
Sketch Of Sewage Disposal System:Provide a view of the sewage cfriposal system,including ties to
at least two permanent reference landmarks or benchmarks.Locate all wefts within 100 feet Locate
where public water supply enters the Wilding,Check one of the boxes below:
"E: hand-sketch in the area below
ligl drawing attached separately
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