2015 May 12 - Sign Off Transmittal Sheet, Floor Plans - Water Damage Repairs �o���� TOWN OF YARMOUTH
- � �O HEALTH DEPARTMENT
a.,,. µ ��
�'�''��E`%� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be compdeted by Applicant:
Building Site Location: �/ 1 '� `C� 1 � o�`�'�
�
Proposed Improvement: �r.'�'c�ilollL. �.]p►r�Y�..�.,,,�o�����G���,,,�", e� St���+�'i"'rt.oc.t�.. u��t�
—�a ��
Applicant: w�u. ,.. �l�lL.� ��v Tel. No.: �'��QQ t 5 1 /
Address: i�'1 (�ir�c� 3~T t�$ R�,)ST..''Y\.._ Date Filed: '�=E�, -(�""
**Ifyou would like e-maid notafication ofsign ofJ;please provide e-mail address:
,Owner Name: ��t�,��R u t�1�t N
Owner Address: 'P� � 0� 31 Sr ��'��3��2..1� Owner Tel.No.: SrO�S 7 3 7 �7(,a
.........................................................................................................................................................................:........................:...............................................................................................................................................................
RESIDENTIAL AND/OR COMIl�RCIAL BUILDING
HEALTH DEPARTMENT: Determines Compliance to State and Town Regula�ions; i.e., Requirements
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 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.
.......................................................................................................................:........................................................................:........................................................................................ .............................................................................
r
REVIEWED BY: DATE: S 1 ! �
PLEASE NOTE
COMMENTS/CONDITIONS:
�
I�
� I
�i
O I
+.+
U
b � � a !
� a W
� 9 c� p i
� � � � �'
�
C3 � s '
,�z
;,ot,it ,,t,it '
_ � o
�
� M ,
N � O �
� V .� '
� Q
vi
�
0 9 :� _ „Z,9 3 '
G� - �� � �' _
pp OO � � 'C bA v,
•� d. ,� `� N �— ub���—' U,� y !
� � T Nyc'�
�✓ � �.� oo d. �,I y`*",�, c� y �
� �
� � �" N p� � c'1 M � " � C�U �
� � � o l - �t 1 ,� ��
@1 M � � � ��g�Z M ��9,�I� U �•'+ ,,
� „i ,9.� a�,�
°�'� o
� o
� � oo � �� �
w �b �
. O. O . . . . : N. N Ob O� .
.-� p '�+" +-y+.� ,�
o � °' °� � 3 �0 :
o �
o � .�
� ;,a
� � �z,
�
tV
i0 � Q
�,£,6 ��b�£I II
�.T�9Z op
�
�
ai
�
i U
� i
i
t
�
�
�
�
H �
�
U
� � � � � :
a� � � p.
Q I 9 � O
o -� � �
�n � � r �
� � �
G � _
„£,tiz
„8,£t .,L.6-
�
U
�
_ � �p �. t�- � O
� .�„ � � � � y� � � � ;�"i
� .� �' � �o
w ~ `" �
� — „L.6— - � �
�°. � 3'�
, �
•� �,tI�Oi--+ u ��ii�6 M �� �
� �
3 „L�Oi � �6 3 p
� °o = � n' -o
�' — . �� M� � _ � ,� �
�:J V� � . c� � M Y . . . � R
� _
�p M � � ��S� M O .�, N '
� „Z,L U ,�
b - ��L, g
� - v,� ' „8.6 �'y
0
a�i ^' V `t O '� "
� N „ � 1 � 3 �
� �
0
� �
�;� o _ �
�7 `C ° � �
� g ~ N �y �
(V � N �
� �
� I
.. � � � . . � '�,..�,...
. . . � �--� ��,
��
ug�zT
00
•-�
c� '
U '
�