HomeMy WebLinkAbout2022 Sign off Transmittal - Addition cinvrincp
';r TOWN OF YARMOUTH
HEALTH DEPARTMENT OCT 1 7 2022
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHW TH DEPT.
To be completed by Applicant:
Building Site Location: I () T-f cry Q +r1 L or t\
Proposesi Impr vement: �- 6eac — ' ' -�(Anai m Q f(�•'1
becif oc� v w- .�. /
Applicant: 7 G '•v\ &re Tel. No.: 77'j did 6/7/ 1‘
Address: D-C), S- /a rr'tc wi'VN-, Date Filed:/ —17�Z
**If you would like e-mail notification of sign off,please provide e-mail address: n e ✓ (-co 61); /d i , , ( d )-7
Owner Name: ve(A A1{ rCc
Owner Address: () LJ-PCf9 41Wi" I l6 �J Owner Tel. No.: S"o2 3°A 6 4)36
J 7 /
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
• fee.
REVIEWED BY: DATE: /0— 7 ` 172'
PLEA E NOTE
COMMENTS/CONDITIONS:
„ll- Certified Plot Plan
Location
Ryyter 10 Georgetown Landing
9
1 South Yarmouth, A14
rigtWiledn/ ,,
Uh.... i prepared for
c-,
SURVEYING •ENGINEERING LI\ George Andreadis
HOME PLANNING & DESIGN I
I- - ' , i Scale: 1” = 30'
3 GIDDIAH HILL ROAD P.O.BOX 439 Date: October ii, 2022
SO.ORLEANS,NIASSACHUSETTS 02662 /
TEL:508.255.8312 FAX:508240.2306 Reference:
Assr's. Nap 70, .PCi. 63
LO.P. 22601-4, Sht. 2
Pl. Bk. 823, _Pg. 23
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/ PROPOSED
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7 EXISTING SEPTIC
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OParlro
: . ,/ 2022
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I certify that the dwelling shown hereon 2:9 V .• —I--r-a r.: 1,-,—
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located as it exists on the ground .<4. -)
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f \ Date: 1,7 k•Y 4---1.) .. 2r i,. ,, '4
Professional Lan.cl,„Sturveyor Job No. 73079
Propo..d.ddI Ofl I
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MASTER BEDROOM II U r ` +IIIII
14-0'%13'-0' 1
FAMILY I •
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BATH FAMILY '�I"
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7 - ,,
r ..,I BEDROOM 3 BATH i
BEDROOM 3 7 _L �-I —
BEDROOM 1 104"X5-ir
KITCHEN i
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KITCHEN
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LIVING =
BEDROOM 2 na^xu'-1^ ry -"' - \\ C
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LIVING -I=
BEDROOM 2 Q 3
Existing Floor Plan Sm �j 1� 61 rn 03
vJ 3
--! a Proposed Floor Plan H o
fil v o g
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1( f ( ( 1 ( ( I ( 10/17/22
SCALE:
Left Elevation Rear Elevation 1/4=1'
SHEET:
P-1
Town of Brewster
Subsurface Sewage Disposal System As-Built information
Street Ate: \C.3 Cc-,.3 y s s....4."., V.-. .1,t c--(2yt� Map:-7 C) Parcel: C
Owner Name: --c 1- ,..bc-CI, permitit: Q. l - D 0
Date installed: 4 ` `a cD 7o). \ New: Repair: ✓
Installer Name: .Ac. r'. ..9L.g' ° Installer Phone: -�Cic- i- .�
Installation of(list all components,both newly Installed and existing to remain in use):
S7 '-' a l c...ec.i-, e V,.,.....11'-,.r_s c3 ti ` --rC)
Leach Capacity tad) 3 c r-t Ground water Depth(inches): >67 '' Health Inspection by: .., ,
(Print clear*in Bladrjekse Ink and Use Straight Ed l Rites and Zabel Alter)
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