HomeMy WebLinkAbout2015 Nov 20 - Sign Off Transmittal Sheet, Plan - Front Entryway �o��qR,,� TOWN OF YARMOUTH
�� � -� `��y HEALTH DEPARTMENT
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� '''��ME`'` ' PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: �� ��`-� �� +��r'� Gf/ ����'�
Proposed Improvement: a"F!���� ��T" � r �.�/�
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Applicant: ����5 fYyl/�'I J� Tel. No.: �� 770 `�/�/
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Address: Z����0� Slr�/� 2�� �� /�� ��G� Date Filed: �� 2� �f
**Ifyou would like e-mail notification of sign o,f�;please provide e-mail address:
Owner Name: _ �r/��J s
C_ ���"7` � �
Owner Address: ,Gf/ P �2�" �� � Owner Tel. No.: �-��7G e%S�
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RESIDENTIAL AND/OR COMMERCIAL BUILDING
HEALTH DEPARTMENT: Deterrnines Compliance to State and Town Regulations; i.e.,Requirements
For Septage Disposal and other Public Health Activities.
Please submit three (�) 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, roo�ng;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
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REVIEWED BY: �/ DATE: // 'X/ "��'
PLEASE NOTE
COMMENTS/CONDITIONS:
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