HomeMy WebLinkAbout2023 Sign off Transmittal - Rebuild Deck 40,E A 4K,1-1f1e ,47/0 „IA : u ,a
ov'Y44 TOWN OF YARMOUTH
3" -c HEALTH DEPARTMENT 44
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4.''1'4 M•''` PERMIT APPLICATION SIGN OFF TRANSMITTALS rE IV E D
To be completed by Applicant: ANR 0 7 2023
Building Site Location: 7 Po27S Ai OcJ /-14 re re to cL HEALTH DEPT.
Proposed Improvement: UiL fJ C1` A i/f its S
Applicant: DA,') A - S peVciii,,'U Tel. No.: `7 2'f u3(
Address: / 6,/A V 2w1 CiT Date Filed: C--/(7/'23
**If you would like e-mail notification of sign off,please provide e-mail address:
Owner Name: T7 G J' ,e3e4S L�y l O l)/),J ;C�v U4 C,
Owner Address: ) / n T O J i f 7 ?R. -C'` Owner Tel. No.: Ca 03- 566 ``y 2`/a
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.
REVIEWED BY: DATE: L7-, /-
PLEASE NOTE
COMMENTS/CONDITIONS:
0i 17%-
LOCATION
-�k&z
DATE
OWNER OF RECORD:
THOMAS D, BEASLEY REVOCABLE TRUST
7 PORTSMOUTH TERRACE
YARMOUTHPORT, MA 02675
REFERENCES:
DEED BOOK 33721 PAGE 120
PLAN BOOK 240 PAGE 27
ASSESSORS MAP 106 PARCEL 31
THE SEPTIC SYSTEM SHOWN IS AN
APPROXIMATE LOCATION BASED ON
BOARD OF HEALTH RECORDS,
RECEIVED
APH 012023
HEALTH OEPT.
SITE PLAN
7 PORTSMOUTH TERRACE
YARMOUTHPORT, MA
PREPARED FOR:
THOMAS D. BEASLEY
REVOCABLE TRUST
SCALE: 1 " — 2.0' MARCH 23, 2023
GRAPHIC SCALE IN FEET
20' 10' 0' 20' 40'
DAN A. SPEAKMAN CONSTRUCRON
LAND SURVEYING do TITLE V ENG/NEER/NG D/V
16 SPEAK WAY
N. HARWICH, MA 02645
508-432-5565