2015 Sep 10 - Sign Off Transmittal Sheet, Floor Plans I
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; =o4�qR,y TOWN OF YARMOUTH
; � - �� HEALTH DEPARTMENT
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�' '^�_*�`��x PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed byApplicant:
Building Site Location: �.J �6 C�i'T/�/, S/�,QfL�
Proposed Improvement: `„ ���� �.2R��h� ���a 6 e�Ira��
� �� �1�a.� 4�c.c.mti�t r= I o ctii'
Applicant: I V 1.(�i �"I�(�(,.) °E- �1 (�t/'lL l��' L�8 Tel. No.:
Address: ��`C� L,GLH.•�� �T7'"�� Date Filed: �U �,S
•*Ifyou would lrke e-mail norification ofsigrr off,please pravide e-mail address:
Owner Name: /V LA ' '�"./ C"1�.�'1 B- lTs—T t7 D
Owner Address: J�Q L.Lc•�,rj �T/�Lt'L�' Owner Tel. No.: { - �- ,j,�
,..._...__........�............._......__.._._....._.__...._..._....................................................._..........................._............_................._......:..................................................._............................._...............................................
RESIDENTIAL AND/OR COMNIERCIAL BUII.DING '
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 ptans not required for decks,sheds, windows, roof:ng;
(3.) If necessary, Title 5 application signed by licensed installer
with fee. '
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REVIEWED BY: � ��� DATE: �/�/S" �
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