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SEPTIC SYSTEM UPGRAOE PLAIi
J,C. ELLIS DESIGN SUBJECT' 55 W|ICHWOOo RoAD
SOUTIi YAFMOUTH, MA
M. OONOTHY EUTTERSC/o PAUL E. CHARRoN
234 VERNON SIREEI
NORWOOo. MA 02082
S.A.S. DETAIL
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SON S, R.S, J EPH REGO, P.L.S
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SECTION OETAIL - COMPONENTS
NO' IO SCTLEEXISTING
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DESIGN CALCULATIONS
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TOWN OF YARMOUTH
HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To hc completed b), Applicant
Building Site Location (E wt+d*-*/-P
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Proposed Improvement:?.,11\"oK ?av n
Applicant:
Address:
Owner Name:
a*ltyou would like e-mail notilcoliotl ofsign oJl, pleasc provide e-mail oddress
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Date Filed:<-,
Owner Address:LS U, 'Jc{"
ureLPk-Owner Tel. No.:-t7 4.
RESIDENTIAL AND/OR COMI\{ERCIAL 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 requiredfor decks, sheds, windo*s, rooJing;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
REVIEWED BY:DATE:l^-ra
COMMENTS/CONDITIONS:
PLEASE NOTtr
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