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HomeMy WebLinkAbout2015 Dec 08 - Sign Off Transmittal, Drawings - 3 Season Room --� _ �., �T _ _ _,� . _ _ .�_ _ ;oF��e,� TOWN OF YARMOUTH � - �� HEALTH DEPARTMENT o $ � '"<•••' ' pERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: Building Site Location: �S� WC1�it 6✓ci f crL �AM Proposed Improvement: 3 Sesiso� f o o»� o� �k �S'1"�� �GG� '—O N SG�n2��r f• c�ll s�-qs� -y��� � ��-���- Applicant: U Tel.NQ.: / i� C«f�tc� IL �o Address: 'L 'Cv� 'r��f Date Filed: /Z T /f "I,J'you would like e-mail notification ofsign o�'please provide e-mail address: Owner Name:�.� `� �o H r.. �ie.S�pz � ,�,�_ — �G1S_ya� - 6yS2 _<� Owner Address: /� I �)s�., wr�rc� �r�� Owner Tel.No.: RESIDENTIAL AND/OR COMIYIERCIAL BUII.,DING � HEALIT-I 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 ezisting 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. ._....._............._...................__......_...__.._...... ......._........._.........._........_......................._........._.....................................:-_....................._........_.........._.�T_......._.........._........._.........................__................... REVIEWED BY: DATE: I o2J�i'f I � \ PLEASE NOTE COMMENTS/CONDTI'IONS: i ; � . {e— `� �o --� � � ` � � s ? � � � f er...�. _ � --_- �^ S � 1 � t 1f S � � � �_ '�{� � "'1 �p �L'� �' 9 N G S � � � J � a � � 4 -�- � � °�i j = '" � Y r' ' o �. � � � � � � � a% � .i�? ,� k o � � �� � �. -�s � � � -S� � ,� 'F� - _ � � � � � � � � Q ' � � _ x�,=° 3-- � s=� � o, a , s� ° � 3 � � , � �s —�,�_,.�1 r�� � � �- ,.� � ___ _ __ __ _ f � � � I /V[1�.� S a cn(6 I �'F! . _. ' I �h �(��� �� I� i ��ba r �� �C. ���n.+`J�l L - � � I i SI,��L'fL �..i.0i;i2 ���WS I i � i T� — --� — ' 1 � � � izkl S ��`� , LX�SiI►JG ���� � . _I� G ' --�-- 6 '--� �� _ � � � we � Wa�� �v �A,/ ��c�a� F � DEC u 8 2015 t�u.rH o�t: 9 .,.,. . :zsa LOT NO. :��.ADDRESS: ISI �+V'�hc�a.a-..� �a. 01JNERS NAAfE: /yJ . ����ir.Ecr�. SEWAGE PERMIT NO. : a �� NEW: REFAIR:� 1 DATE ISSUEll �7 a. DATE INSTALLED: -� �/1 EMSTALLERS NA�: �(�ys (�Coj Q�,•rt'(' , /Sao /G K�-Gv/ius��-�,�s INSTALLATIOtI OF: r . r f' 3� /e" �.�,O oyL��1J� �l�t�sd WATER TABLE:I�iL�� � NA�, INSPECTION BY:� DRAWZNG OF INSTALLATION ON REVERSE SIDE: __��o��� ��ti�om cd�� �uew�o ` �s ) ��.I�(�c— TOP �� � 6 , � � •, � � �, � � �- - � --- `�' � ( Z �f � �u��` 1 ��i � ` � i ��� A- �� � A,; _�,4 � 'f; _S,, � ,., a-� -�a.s 3 .• � A-S ' 7S•3 �ISUV � Li-� - �3.4 S ; 6-2- - i4�5 6-'� - aa•� ,� t',-`F • 3S•7 � f1-5 � �f!`