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HomeMy WebLinkAbout2007 Nov 27 - Sign Off Transmittal Sheet, Plan - Car Port u -w�_ �".,,.�..�--,�-�f�O,�''�..�. . w �� � _� � ,�°��Y_ �o TOWN OF YARMOUTH o _ � y HEALTH DEPARTMENT N�j,M"�a.a.����5�,�$_ ' PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: � ' Building Site Location: y �l�/ `t' 7"( �_ � {�(�c Map No.: Lot No.: � Proposed Improvement: �y� �',�� r �j�'X t� �����-��i-� � �r �..-�G,c�S � ! A licant: � PP ��°.vt �_-��.t l,.• 'E-l��R.i� Tel. No.:S"�(��? - 3�� ' �16-� tlddress: � t.li�t �~�r ie � ���4 c� Date Filed: !/� 2 7 - b� ' **Ifyou would like e-mail notification o.f'sign off,please provide e-mail address: � .,... �.�, Owner Name: ��n n�t N +--� �n�� Owner Address: S•���-- Oumer Tel. No.:��H'` �' I' � i .............._............_.............. --....................--...................-.._......................--��--................----..........................._.--------�---�---------._..........-------�------------....._._.......................-------------------------.....-�--------------------- � � i 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. � I Please submit four (4) copies of plans, to include: j (1.) Site Plan showing existing buildings, water line location, � and septic system location; (2.) Floor plan labeling ALL rooms within building I (all ezistiag and proposed}— � Note: F7oor plans not required for decks, sheds, windows, rooftng; (3.) If necessary, Title 5 application signed by licensed installer with fee. ...................... . ...................... ............ .- -.. ..........--- --- ........--..... --�- -......._......--�- - -...................... �� ---.................-�-�---...---..........-�-- ---......................_...--�---..................--�--��- --.. REVIEWED BY: ; DATE: �� � � PLEASE NOTE � COIVIlVIENTSiCONDITIONS: � , ; ,5</E27 / o�� L S�'/E�C"�S'� : ;- � y � <{ � � �> � , . . /] - • � �� ! j� • � � �r "E � , ,� �.sr i � ,Z9.99 -- —— �, - --- � . o .. - , 3 . � Ec..�•s . , �3z s9 , �� , Ec ��� , ; � . _ . � � p � ` ����°�1 � 7 �Ou7 : ° �. , . �/� .,.�. � . { � S/.G � _ _ ��'..�.7 G� � � EY.S/..2 ,(07`"'2�2 � ,LoT °'.2/ � � � . � . ,c? .S",2G S�nr. FT, �9 � � Ef.S/.7 � � " �---' G 3�� -'�---�- h � Q Ez.s/8 � Ec..�,¢ \ � �� Pzo�oosEa Qvi�.D/.vC 'h - � �L/1! Te�D OF FOuiVOAT/ON= SZ.O �J . -�`�l 30�� _�,. �, 1�1'� �� . �c.�'/./ ��-�� !�j ,o 7- . ti "� 'Z/� o-s�c Z/' - 3G,/3 ° 1 � � ,�e,�,�c � ,� e=s� 7/ P ,�,,� 3�� � ° 3 � q=s�L3 4 �Pl.�" �. --h�� F�,�,.Q� ' T�ia.�c.E 8� a�sr. �,� RN_•Sf..� 6' �� BoX � 3 � qa� #4 " ��s�z �j'= � � 1 'K�.o , , __ ' .75:70 " �9=-�'6,�,z -- El.So. ',f Et.s'/.8 K.¢8.3 EG sC�2 PQ���� wNiTT/t�2 AL�9C�. t�Aa. w�orN . ��� NoT� ELFY�9Tio�vS BASED vN ASSv��°'� D�T��y CERTI FI ED PLOT PLA N '7�1�" �DC-�lCN L�71/'G:NE�� s/S/�2G. Bc�" �G- po.�tslBLE'' -T�o�� �L�' /�'���v LDCATION .WE.sT ,�/A,eMou7�/�,MAsS . ,r.�vn ��T7f=i cA 77ati ot- T1-1� S�WiAC� Sy�s rP-�y ,�+-s s�b��./ oN�TN�.�-�DP�vf� SCALE . !.��=30 ' . . . . DATE .o,cT:Z4.i9�7, nG,q�v�. PLAN REFERENCE . .c3�yG..:Lo?: �"�?� . . .. . . �� �" '� ,,rNow.✓ u.� L�vq , �'o�,zT P�qni 347.2g C �Rr�r�.u�, t ,SN� :Z,oF Z.sNEE7'.S . . . . . . . . . . . . . . . . �OF►:r. `�4�~`' 21:, I,�;/+ �� . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . ( r� ED(!_ �^.� � � . � . . . . �� .. �t i:, �' .: «E C�LEY N . . . . . . . . . . . . . . . . . . . . . . s+. �v o ?..,1 u:� ' I CERTI FY TNAT TH E !�?D�?ds. . �,�� ,vic oin�C. �� . ,.... . . . ... �c1�TC�`/U`� '` SHOWN ON THtS PLAN�iS IOCAT D ON THE GROUND I ��,��u��,�-� � . . AS SHOWN H I�EOFi AND 7HAT IT CONFORMS TO THE ' S _. SETBAC �t�,UIREta�NTS OF THE TOWN OF ���'�� � .�J�'f��N"�. . . . . . . . . WHEN CONSTRUCTED. � �'E,vE- P. T�EVEAv DAT ¢.�T Z,4, �977 ,, PETITIONER:4/¢ 1n/EsT }/AK/loaTN �2os� �1�.'�v�-� f' ;��lc'! W�r yq,e/yo�rK, MRSS. REOISTERED LAND SURVEYOR