The URL can be used to link to this page

Home My WebLink About2016 Jan 19 - Sign Off Transmittal Sheet, Floor Plan Sketches - Bathroom Remodel _, ___._ _ � .,. _ ��.._ . ��_ _ _ _ _ - �o�� TOWN OF YARMOUTH �� w�� HEALTH DEFARTMENT � � �"'��N�``� � PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To he completed by Applicant: Building Site Location: � � ��p=, ��C�S �c uP,✓" Proposed Improvement: ,�� re�.o c�P,�(� Applicant: 1_..,,!",�'r�� }-y-�.Li Tel.No.:�� YU� ,i��{ � Address: � � � Date Filed: � �� l� �- **If you would like e-mail notification of sign of�j;please provide e-mail address: Owner Name: �,/t'jc�v Y.. � L�,s�� tv� Owner Address:��r� �� f_�� /Q�- Qwner Tel.No.: ..........................................................................................................................:.............................................................:.........:......................................................................:................:......:.....................:.......................................... RESIDENTIAL AND/OR COMMERCIAL BUII..DING HEALTH DEPARTMENT: Deterrnines 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 Pla.n showing existing buildings,wat�r lin�location, and septic system location; (2.) Floor plan labeling ALL rooms within building (all ezisting and proposed) — Note:Floor plans not required for decks,sheds, windows, roafang; (3.) If necessary, Title 5 application signed by licensed installer with fee. ..................................................................................................................................................................................................................................................................................................................:..................................................... REVIEWED BY: (JCQ/'�� DATE: `''��G PLEASE NOTE CO NTS/CONDITIONS: ,, , � �i � . �� ,.er � � ' l�t°G�' 5��' � � � � � . � r,,,s n�u/ , '� � f3ut�a � t I � .t � �� , a ` � � ��1 ,� �� ; . _ �� .�� r�� ..r.��.�P�.�2�� _v.�._�.3 ��. �� ; � ; : � , � Yar outh Health Department —�-�� . APPR VED ;;---�-�i. � � � _ y . . , . ; I �— � ` _ _ � DStC V t w�Q(�l � �� I I t ___ ' ! �' �{`s-� � ��.�-� a�,�� ``�� ' � , , � , ; � - :- � � �� %�'�� '�� `�� mn.�..�� !_. � ` � �,A. � �� t= �� £ ��r�"``� ��o i,,r (------__a .� y�� I `�� t� i ,�G�` ( � 1 i � � 1 . � � �� . j � d �� . . � _ �*"�"� . � \l� . V � x ; , i t � � �� ' .. �. .__.____. ,. . _. ..._ -_'_�.'�—r_.__.,.. ii ""i i � ,. . �_ i � i�,'�p�"i ��y�'+.� -�,�` s � {� �'`�1�� +" _ ' ��J'�� „ � ,`�� ,�� # t � �. � � ` } � ,� � , �� : � : F,p � � - ._ _ - � f , , . � . , � -�-______________ -- � G �� ' - ;�� . � - , �'� ;�'"' ' �L �'tia� `{ �O`��Y ��ItY`e� � ��" i ; �_�_ _. �_.____._ L � : �._Td� � !�{ t`�� t �Gl t��"` ' —_---- _ _ ___ ______-- ��?�J�_ � E�~?''�' ' � , �"r �' , -�X��_��'_'�� ._--__ _ �tc�i ��S � G�'��' � ��:V t .JG?t1 j`� �,�'w^:�°k '�� . ____ ._ _._. . �_...�....��.�__.. __.. �'� / ��,��/� �'�rxn��j�h �iealth 1[�epartment ; APP VED � ��7 ame Date (