HomeMy WebLinkAbout2016 Mar 18 - Sign Off Transmittal Sheet, Floor Plans - Basement oF�q�e TOWN OF YARMOUTH
�� -�'`� ��`��
_�� HEALTH DEPARTMENT
o�.� �
� ''r� �f`�� � PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: � E 0 �
_ ➢��
Propose�d Improvement: Pt �, I�c,S P h � r►.• � �� ( a��oorti
G I V�..,�5 n�t I- G Y ��e 3.�+ / d^i4S�-cr dt ��+ t Qon �i...
Applicant: � ��c d bS Tel. No.: 5 CJGp � �i y � `/v 6
` �Qt,r,`f {�
Address: �0 �tJ'�f�"" .�y`� ! �o a 7� r�$ �,�lh i ���Ps �b��•Q Date Filed:� "�C1"f �
**If you would like e-maid not f cation of sign of�j;please provide e-mail address:
Owner Name: i Ci��l�S ���P n�PS
Owner Address: � �1,5�„�/ k�� Owner Tel. No.:
..................................................................................................................................................................................................:..........................................................................................................:....................................................
RESIDENTIAL AND/OR COMMERCIAL BUILDING
,,-�
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e.,Rec�`uirements
For Septa.ge Disposal and other Public Health Activities.
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 egisting and proposed) —
Note:Floor plans not required for decks,sheds, windows, roofing;
, (3.) If necessary, Title 5 application signed by licensed installer
with fee.
................................................................................. ...................................:............... .....::.......................................................................................................................................................................................................................
REVIEWED BY: DATE: � ` �U�� �'� ..
PLEASE NOTE
COMMENTS/CONDITIONS:
U+- �.t„�i Vu —
��n/ ..,.
I
� o� l�� �`� "ti"'
�
� �
� � � a 7-
� � �► o W s
a � o �
o �, � � co J �
V 5 � -
� � �] r� � Q�
� � � � � _ �
�
� �V
7`' �-
� �
��� b
d
l'tf
� ��
7
Q �
�
^1�^
I ✓
��/
,��(��' ��
�
�
�
�
�
� �
�
� ��
�
�,/ � � �
Y
� � ��ti
�� � �� � �
� � �
3 �
. �-
J
�
� �
��y �
V
`�J �
� �'�
V �
�1. � � "�.,..
� �
� �� �
� �
�
� �
_ o � a
� � � W
f��[��/ � � _
� � . ,,,� �i J .
(v
�
� ..�� i
�
��� � .
� � �
�
�/
�� �
� !`
�.o\rr
� �+.ti.r
��'`�
S!
! �
� ^
,��, ��-.
�� �� '�
�, � .�
��