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Home My WebLink About2015 Apr 21 - Sign Off Transmittal Sheet, Plans - New 2BR House - ,o!�-'Y�� TOWN OF YARMOUTH , .,,..,�,� �� t�=� HEALTH DEPARTMENT o:,� ;�LL _ ,� ��''��=�-``�� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: � Building Site Location: � V� f � �� "�� Proposed Improvement: � �S��-\p �� ` �� +� Applicant: -- `�� i � Tel. No.: � - ' � �� \ ,,�r Address: ,1�. � , (/✓ Date Filed: �-t "Z � -� **Ifyou would like e-mail notiftcation ofsign off,please provide e-mail address: O I �� <'G �'� .Q� � Gl Ll OE' � Owner Name: �� %(�(�� Owner'Address: Owner Tel. No.: RESIDENTIAL AND/OR COMMERCIAL BUILDING HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements For Septage 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 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. ............................................................................ .�............. , REVIEWED BY: �/ � / � DATE: �f `� ..L� �� PLEASE NOTE � COIV��S/CONDI�IO �: ` � ' � �� /� I � /� I�%�� ✓ C r11 . 4 �� e � . : , . ' . . ob� a � � y 24 ��x�: � t �_ a a� � � � �� i��-pI�� : �� s��:' � E �� f �k r � S f o ` c�� O R �s�tt ��g�� p � �� ` :6 �+Q�^`�� x m� :� � >"� W �k� � Id � � �� U�i � i A g R �� z a. > N G � � � _� � � ; � v't,. 5 Tc� � � �� j�� €� � i 1&.��T 'EQRF ��- 6 � � ��::ni� ��i� i�£� ,.�.., Q '�IH:3` ? 4 � ��g� � � � �� s � �� fi � $7!R :� 5y�} -�� -`� � . t,`�„� �S tl [ RC e��1F�8 � kE� � � i � R � � � �� W � �� G �3�� `4 ,�s`•4 �� `'y;� � �`�'� � � .- Po� p � r '°'6 � �� i 'a, a�� i ; b. , •\ 't�s�' ,. �a �, � Q r ; �� ! ,: � . J � �! Qp R .� � �� _` C i�� 1@ , ��z .\ � �� , � � r ��` � � �7 r�� ; I` ��;�'` i" t.. �` � .� r , '� �� o' r � `'' � �� `!, ��.` c r� } �� / O� ��`� � '� `'\ ! �— �' i. � : u '� / �$;PC€� \ � (�' ' ,' N• �� \ t I r i k ti. �r� �\ \ � s� r \ ~" �" ~ ;'� � a" 6 �� ' � � � 1 �� 7 j � E ;� �.� � � �i� � r .? � •� 1� ' � �. { � � 1 � � �i� Q �r m � � f � i `- � �`"' �g f � E 1 E� t.LI O C � �f /£� �`� M � �� '� � a � ,e 1 �`�`' � o m �:, $� � �I ¢ w « :� .�r... �� ; Q � � � i ; ; � , a z � �� < fl? Z Q � ► F t ; � � ,� = � : � . �� Q �. � `� \ ' � - Ct�.t C3 � " � �} ° _F`�"�� ^� -� �� Z � ;� � -� �. �� n Z i � 's � `� wp � .,_ @ � s � Q p ¢ „as � m� � ��R � � � � � Q 4 �� Q � -� � � 4 � � y� \. ��4�3 '� �Wa � x \ Op` � � � �� ',� �°� � N \ g�� K� d f ��' � � � I '�� _�� '�; � � _- ��° � � I � : ��fl a � � E � ^ �¢� ��jW� � � � � �, � C "�'E' �� }�y m � S p � �, FC� � Z� I i g �n ' rp Z � / � ��_ � � � � � � � ' /d�� 2� � I � �6'�s6 F �_-'�` � �o�� a a g I I s � � �° � /