HomeMy WebLinkAbout2023 Sign off Transmittal - Deck Replacement TOWN OF YARMOUTH
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HEALTH DEPARTMENT
''- PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant. 2 /�
Building Site Location: J/ (/,4' 11',/ /A/
Proposed Improvement: -e&LA-Ca- ' ? iAi6 004 C L.)/(,sb 5-c
1).t ALL
Applicant: AIMSia-T;C Tel. No.:
Address: it ,&1-t 4' L�' 1.�1,6Y , Cora? Tl *A(026 33— Date Filed: 44/23
**If you would like e-mail notification of sign off please provide e-mail address:
Owner Name: (2-i-4' 1- 61,-/9- /-7-;e4-
Owner Address: ✓3 t/ ,¢C�r'i pTJ� �,L. ✓ P-✓6� Owner Tel. No.: /,l 2J'O2 "
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.
............. l
REVIEWED BY: DATE: ( L�C ` )-
PLEASE NOTE
COMMENTS/CONDITIONS: �',
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Commonwealth of Massachusetts
rt_, - = Title 5 Official Inspection Form
,-_== „ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
33 Vacation Lane
Property Address
MCDONALD MICHAEL J LIFE EST
Owner Owner's Name
informosquir ofotion West Yarmouth MA 02673 03/16/2020
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
14. Sketch Of Sewage Disposal System:
Provide a view of the sewage disposal system, including ties to at least two permanent reference
landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters
the building. Check one of the boxes below:
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