HomeMy WebLinkAboutBayside Runner BOH application sign off sheet 1/8/13 Tom Pena _-
Outside Sales Manager t. ,
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Store_508.591.8422
Cell(best)_617.688.4245 •
E-Mail_tompena@baysiderunner.com
Fax_508.591.8412
www.baysiderunner.com
38 Long Pond Road. Plymouth, MA 02360
oY�Yq� TOWN OF YARMOUTH
'(;• 4 ��- �` HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: y S So,AI t S 1-6 0, �� A✓c
Proposed Improvement: R S 1-U c S /t — 0 5 e- Pi•s..V 0 c c u PA IJ C`(
A MD PROP roc R D vna n (,L.A LI -
Applicant: B(.k.) 5 ,c:i s lqu e✓ L L C - -To ,v, Pen 0, Tel. No.: 6/ 7 - S S' - '-t 2 '-+S
Address: 3 c Pc,r,c-I / I di f h Date Filed:
**Ifyou would like e-mail notification of sign off,please provide e-mail address: -I- p e 4 U p bm 7 ( -+tea.,et. (a,A,
Owner Name: �a� S , c� ���.�e L LL
i
Owner Address: 3 5 L a /c,( (" I n,c , f h Owner Tel. No.: 61 7- 6 S'c.- Z 'IS
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: /^ 1 J
PLEASE NOTE
COMMENTS/CONDITIONS:
484 South Station Avenue, Yarmouth
JAN 08 2013
HEALTH DEPT.
30' 5' 50'
.
.,. _ .
8 ,Accessible
t 0 !
,- Dressing
ii Room
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16' 4, 1 ,
, ,..,,,,i, , i
, Check-out ! i
r'• ..', Office ' : • ,.
Dressing
Room i.
5' Toilet Toilet
Existing Wall , _,. , Door 85'
New Wall Window