HomeMy WebLinkAbout2015 Apr 21 - Sign Off Transmittal Sheet, Floor Plans �;d'�;;a!?.� TOWN OF YARMOUTH
�' -� `�'}°�c� HEALTH DEPARTMENT
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�'�M�MCNE%'�' PERMIT APPLICATION SIGN OFF TRANS1t��TTAL SH�ET
To be completed by Applicant:
Building Site Location: � �-2 1 `��� � �(�-�--
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Proposed Improvement: � w�,0�,i �"�t O�..S�..- �a��t7'✓1 � C�,
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Applicant:��0 �, • M Gvl �'1� Tel. No.: �U� 2 -3q �?j
Address: �� M �`�.�v I Date Filed: �...� 2 U � �J
**Ifyou woudd like e-maid notification ofsign o,f);pdease provide e-maid address:
Owner Name: h IrU► `� M C l OV�,�
Owner Address: � `,�.,11�t. 1,6L Owner Tel.No.. q� �5 `Z� �1� 2.
RESIDENTIAL AND/OR COMMERCIAL BUILDING
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements �
For Septage Disposal and oth.er Public Health Activities. I
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 plans not required for decks,sheds, windows, roofing; ',
(3.) If necessary, Title 5 application signed by licensed installer ;
with fee. , �'
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REVIEWED BY: DATE: L � f ;
PLEASE NOTE I
COMMENTS/CONDITIO S: � i
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