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Home My WebLink About2023 Sign off Transmittal .. .0� .:'' ''4, TOWN OF YARMOUTH �: c.c. DEPARTMENT PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To he completed by Applicant. / 1 �/f Building Site Location: 7 �� R) /at'r-toi/A ar'� if ��CP?S DlJ � nProposecImprov9 e/nt:AO 4 aA - G�ec.LC r`.c r- and le`l/ t a di- koN,e wr�/,At Gc,lO� eN `s `t 54 ry �a,n � X PO J7 C)LA SGtict L- c•c //to 0.4-.` Applicant: -Q/ 1 $ IL Tel. No.: -O g/$' 7WO Address: S /tY'l .1' -Gle /" QT'trr Alt 24 S Date Filed: //q/�3 **If you would like e-mail notification of sign off please provide e-mail address: --ia4-1/e�/no brOSGG.ej,,,ict/4l,6-1;4'1 Owner Name: laIry/ Lgfrn 0n GO Owner Address: 020 1-koir ii Or. Wood.br e T ,sgs Owner Tel. No.: .1G3-67(- F537 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: JAN 0 Y 2023 (1.) Site Plan showing existing buildings, water line location, and septic system location; HEALTH DEPT. (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: 2 .i DATE: 1 PLEASE NOTE /G , COMMENTS/CONDITIONS: i 7-----r ; t //X 11 P r 0 0 s Tts ay.,,-(ecA 0,-,J ,s4r4444 i -T---i T—i-1-1- , , 14 'I x 4f lAih;fe. 7? eni)ste-te(.)1 ,114,5,leetie , 1- \ 4 ' 6'1 le 1,‘/A)- 7lerLerlee,k ra\li Idts t...... . 1 v.,4 eitiot im111,este r, . :.:,•4,:'?;`'I''‘, 4 . . 1 4=_______ •i ' 1 I . ----r-1- - 1 eS/ if Atet i t . 1 1 1 I ri Friri-1-11-7 , I : , . , , i ,' 1.4) , I 1 1 • -4=. Anm...____ 1.___.......... ?.- ()) p,4134,e1 v;-,L), P-Tqo A- i( Wrof i ......,, .., • 7 - ‘ (3)e).-n i3e oro pt,i, „ 1 J... . r ' Z. ,,,S Telp56,Alt c eol el e r-/Of--4 . .. ,...•:: - — • 1 4 ,/, 0 . 4 - .,.........,I :1, "---- ......"._. _ r ! • t. ( . I i 1 1 i i; 6111 ,3;se..5-ali- wt, 4,4 I?" f-tte Lire/op.-II 0 . . • .. - • - • g 2 OZ3 ' - • --c-1.-1 DEPT - - - . - -- - -. . - -- -4.4 , ;f t m ''..• :rt. 7 ! .. I • i i q .•••! I: 4 U . . 4 1 il—; 1 3 Si ;-fi : 4-0 gr r. ,To • -: • ._4, F iii. zt pr A i " ;alt r4 -r -.741 a 11.1 il "; \ •:• t 7:: :••• It • • •7 it .- .•''" 3 ... 47,s§ t'IA ".. 1; -0 r.—.. : i ti%.... g!t.4 # ef4•, - ;IA -!...2 . -r e• . . • • ''' ...., . '''ffIff C .''t7 .....,+•". ".•••••• ji - .-.. . Alif 4 14,f4 •- •.:t`.• 3) ., !.."... 4 -•ir:-:?, ....- - . ! — - ii • N.I. r:. . I I t I,; : — ir" ', , • c' !•••*. •.- • * Z ... 2 . . • . 4 ' • . • . . . . - ., _:,, _ a'3 n 4 ?.. _ ,... ..,. t::::. - - -- • . ..,I, , . • -..„ .,,„ . -- •• _ . _ _ _ - - - - .. - . 41 1 ...: _ . . • - . • -.., i• . , _ .. . .• - ___---•••,.:-'..it - ....-• . . .. t.... • .,-• ' . , 7-3...."*" •'- _ - - CO ... ., . - ... „••••• — ..-...--..a _.. - ,„er -. • t7:- _ • 4-13 • - • : .. 'IN 4 ,• ,.:. . '• !.: .. st;.* ... Z - • . . v -1 b . ......._, ,.. . 7...,., i. 4. In • . .• , - • ,• :!'.,3 •"4 • , s:' ' :::--"----- .-...--,,:.—i----.. _,...... .......i q-1 - • 40. .., . • - , 1 4...4 .:•(-7:2„. 14::r . : . -...,",. . ' . irtii . '• 0 ' _ ... ...-4, • -.. . f - a It la -• t • r- ' ../2...i '17- ,.. -...........__.( - -Imr••••... ...— ,L,s. u o .... , • Town of Yarmouth � Subsurface;� Sewage Disposal System As-Built information Street Address: ``I c� ,+ _) 3 0-D Map: /3 ) Parcel: 1O Owner Name: V QJr(r-A ) yk 1� 0—FA Permit#:tLC" Zz- 0/2-0 Date Installed: (O k3 \ 7,7_ New: Repair: t.---V Installer Blame: (� (�e�"� �T ��- 2ô. Installer Phonef /�'09 477 88�7 � installation of(list all components, both newly installed and existing to remain In use): l 14 (0 1500 csGi • ikt-1 lL t 1-4 1)•13 -4 (5) LC--fp c N gLy--5 Leach Capacity(god): 3;30 Ground Water Depth(Inches): Health Inspection by:i l,,ic ehdf- As-built Diagram (Print Clearly In Black/Blue Ink and Use Straight Edge—Label Risers and/Zabel Filter) -.../-7 (,- -TPL-----\• �o\�r . , . ..n., cif, 3c ecv.lt-1) fC co /77--------I 3 • NOV 0 7 20 IHEALTH DEPT % 5 A B 111 C D E F G 2 Z3 3 _—. — 3 33•i ` 40.E `__ 4 3/. 3f3. 2- 5 42 0 _ .4(01 - ___ ___ • 10