HomeMy WebLinkAbout2022 Sign off Transmittal - 2nd Floor Deck 0 in, ,S TOWN OF YARMOUTH
;7.441,1, c,e. HEALTH DEPARTMENT
'' PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: q .'l 1mM�i,r' . \ rnO&M Y`i-`Ar ( 0-15
Proposed Improvement: ' \ C'12GI�- ( �(1 "r Y e- tc - -hne- Ir o' '-e,
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Applicant: I t'A rCex/Jsrr►4-11 (CCtcr4ll�Jrf�"fllGk O(1 Tel. No.:up I9-1225 "
Address: 3EL lurrotv.e Svr., Carrk/n mot- O20 -t Date Filed:---4442-1-1"44
**lfyou would like e-mail notification of sign off please provide e-mail address: I► c°Oe tPl icon5' er,ryl
Owner Name: -/tt k2 V\-oe Ccse l�
Owner Address: `l fYmer^' S . et-moo-ITN - 02lo-IS Owner Tel. No.:FjO%),9-115 -3 Q
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;
per 0 2 2022 (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.
REVIEWED BY: 91"174. DATE: ( ),../ c/�2-
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PLEASE NOTE
COMMENTS/CONDITIONS:
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.i ' CERTIFIED TIFIED PLOT PLAN
PREPARED FOR:
„if' DOUG HEYWOOD
4� LOCATION : 4 SUMMER STREET
' YARMO UTHPOR T, MA
cos; PARCEL 93
/ zo". 96,991± SQ. Fr. I SCALE: 1" = 60' DATE: JUNE 21, 2000
'�. REFERENCE : ASSESS. MAP 122 PCL 93
I HEREBY CLFtIIFY THAT THE STRUCTURE
mGx\ SHOWN ON THIS PLAN IS LOCATED ON THE
GROUND AS SHOWN HEREON.
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THE FOUNDATION SHOWN IS
0.6' BELOW THE HIGH POINT
IN SUMMER STREET.
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: 3624541 laSOo ix??¢S `v\ M ASS
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down cape engineering, inc. .zstig H. \ -
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CIVIL ENGINEERS No. '13 cc
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LAND SURVEYORS ��" 6'1 •y:
939'main st. yarmouth, ma 02675 _thilZ __ _
JOB #99-346 DATE REG. LAND SURVEYOR
MAP NO. /a
LOT NO. : 93 ADDRESS : if su' a 5 4-
OWNERS NAME : 5'2ar- P urn 4- u
SEWAGE PERMIT NO. : oc, - co NEW: REPAIR: ✓
DATE ISSUED:1 ltt-° DATE INSTALLED : Qy-23 - °a
INSTALLERS NAME : C ,t_i,, , Fht- Ya Yvag
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INSTALLATION OF: ,2S oo r-{ao (' « x 545- /n Al�'alvd
WATER TABLE :/v04-FINAL INSPECTION BY: 34„, +
Lfik�lc^s RS
DRAWING OF INSTALLATION ON REVERSE SIDE :
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