HomeMy WebLinkAbout2015 Jul 15 - Sign Off Transmittal Sheet, Plan - 1 Car Garage _ ,
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roF��� TOWN OF YARMOUTH
�� HEALTI3 DEPARTMENT
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� '�•_ •`� � PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location:� �' �( ' � �..t r ����A/l [la n vr�-h m A � U Z� 73
Proposed Improvement: � (' A (,�,� n a r Q � 1 k Z� <� t�.� r,� �"�n rn �
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Applicant: i C �F- � '� Tel. No.:� 7 y —2l L- o / 3 /
Address: � ' r' Date Filed: �T—� f� < <
**lfyou would like e-mai[notification ofsign off,please provide e-mail address:
Owner Name:
Owner Address: Owner Tel.No.:
RESIDENFIAL AND/0R COMbIERCIAL BUILDING
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e.,Requirements
For Septage Disposal and other Public Health Activities.
Plesse submit three (3) copies of plans, to include:
(1.) Site Pl�n showing ezisting buildings,water line location,
and septic system location;
(2.) Floor plan labeling ALL rooms within building
(all ezisting and proposed)—
Note:F7oor plans not required for decks,sheds, windows, roofing;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
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REVIEWED BY: DATE:/ � ) � ( S �
PLEASE NOTE
COMR�NTS/CONDITIONS:
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HOBIN '
�^w LOT 39
ea aisai � 10,000 S.F. f ' -
roo-�' SEPT/CS FROM 80H
�+ ''.9S BU/L T'" CARD
TO THE BEST OF MY INFORMATION, ��EXISTING" PLOT PLAN
KNOWLEDGE, AND BELIEF THE WEST �ARM�UTH; MASS.
STRUCTURES SHOWN ON THIS PLAN LOT 99, PL 8K. 246 PG. 142
HAS BEEN LOCATED ON THE GROUND pq-� SCALE 1" = 20'
AS INDICAT�D;�, :- ^ �pg 7474-0� CLIENT�(EF7N
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� i��,E��� SWEETSER ENGINEERING
J 2O �¢ n 203 SETUCKET ROAD
PO BOX 713 SOUTH DENNIS. MA 02860
DATE PROFESSIONAL LAND SURVEYOR � ��6� F,�. �-�-e��