HomeMy WebLinkAbout2015 Dec 23 - Sign Off Transmittal Sheet, Plans - Swimming Pool ,.
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�o�'.--�„Y-aR,,� TOWN OF YARMOUTH
� -- �-��� HEALTH DEPARTMENT
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� �''��E`'� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET i
To be completed by Applicant: '
Building Site Location: l � G7?�1 `
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Proposed Improvement: � �c v��
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Applicant: '� Tel.No.:S�C��— �S'D---��� �
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� Address: � Date Filed: /� '
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**Ifyou would like e-mail notiftcation ofsign off,please provide e-mail address:
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� �wner Name: Q --���.
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Owner Address: Owner Tel.No.: �P��'���y�(0�
' ..................................:..........................._�- ..._1..... ........�.1...'-''��..•...•.•..............................................................:
RESIDENTIAL AND/OR COMII�RCIAL BUILDING
HEALTH DEPARTMENT: Deterrnines Compliance to State and Town Regulatians; i.e.,Requirements
For Septage Disposal and other Public Health Activities.
Please submit three (3) copies of plans, to include:
(l.) Site Plan showing existing buildings, water line 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, roofing;
(3.) If necessary, Title 5 applieation signed by licensed installer
with fee.
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REVIEWED BY: - DATE: ��'` o'� � �.��
PLEASE NOTE
COMMENTS/CONDI�'IONS: �
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