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HomeMy WebLinkAbout2009 Feb 13 - Sign Off Transmittal Sheet, Floor Plan - 3rd Floor Office, 1/2 Bath .�.;�� ... :'-. .�... .;. _ ..se.�...�w`4"�T"�r:�"'���'�«k�+:1r:,---s.e.: . . .. . .�.�et_'*�`�:"�". F�'+�r�e"`_� �.a.,. '��7��... �; :- -� . . < . 'tr r= . .,mM�s�s - , .., . i � ' `� I ,�°��Y��o TOWN OF YAtRMOUTH 'k � � y HEALTH DEPARTMENT j � N MATTA M 5 � � ��`°�"""°��'� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET � � � � � To be completed by Applicant: ;Building Site Location: s° �G��� Map No.: l� Lot No.: �8 t Proposed Improvement: U��'�k- , /-L Bl�i"�i ` 3 n� �c.oa�C ; i f E � Applicant: /�'L4�sx �-t�iuNE�l Tel. No.: �`� "�� �y�� i I Address: �o�C ��� 1 /�il�f�►�S ��t�ltLE-S , !�'°A ��6�� Date Filed: Z �3 °9 i � **Ifyou would like e-mail notification ofsign off,please provide e-mail address: � i f Owner Name: ('��k� �'�s�Z� I . I Owner Address: Sd f�z���� ��� ����"�� �`� Owner Tel. No.: �5�� ��4 - �b 77 ; � --�-----��-------------------�-----�---....-----..._-..._................------��-�---...................._................--......._........_..._......_...-..-�--------............._..--�-----------��--------�-------------_..__.....------�---.........-�-�----�---------..........._._.........._....._._.._..._.... � ; RESIDENTIAL AND/OR COMMERCIAL BUILDING � � f ' i HEALTH DEPARTMENT: Determines Compliance to State and �'own Regulations; i.e., Requirements � For Septage Disposal and other Public Health Activities. � I Please submit four(4) copies of plans, to include: ; (l.) Site Plan showing ezisting buildings, water liae location, f and septic system location; i � (2.) Floor plan labeling ALL rooms within building � (all ezisting and proposed)— N+�te: F[oor plans not required for decks, sheds, windows, roofing; j (3.) If necessary, Title 5 appli+cation signed by licensed installer i � with fee. ; .....................................�-�-�---.........................--�-------...................-�-��---�---..............-� ...-�------.......-��-�------------------�--�-----�-��- -�� ........---- -��-�--��--- -���--...................-�---.....-�--�---................._....._.......:..................._........... �U' /, ; c� � REVIEWED BY: �-(tJ�G��� DATE: -2 — /�7 T d / r I PLEASE NOTE ' COMN�NTS/CONDITIONS: � !'l,E'/ liG'�f�-" D' 'S�G��'L/S'/t�l t7� 1'7`''G,I���- '' ��� � L , i 4 � f f ! � � I$ � { ! , , � • w c ca _--- .��. � �. �, � ; ��' `� � u.� � � ° � � � � �� � " � � o ,, _o � � � � z � � + � � _ .� CL ' 1 : .� z � � Q �i. a � -� x _� c� `� � � � � � � I 3 � ' ��..�_.___ � � �; % -- y 4� � �-- s -� 3 � - - - - - - - - � � :� � � f� T � � V. � � � � _ � J � � � M /'\ � � � N � � � � �l` T A � � �� � � � x P- '� '� s� 3 a a �r r � • a Y.�^ � N} � � - - - - - �_ � �� -�1 � M � T � � �y � �/ � � � ` � �� � �J � . � k ��^ 1 o R � �� � � - t'^ � / N''�� . � � � M \ � � � � � N � � � � � � � , � � N �, �