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2016 Apr 11 - Sign Off Transmittal Sheet, Floor Plan - Water Damage Repair
t - _,���:�-�-�-:_ , �� : � i ! .o!�-'Yq� ; TOWN OF YARMOUTH ��� ' �, � � ��`- ;° HEALTH DEPARTMENT � �:._� -�J-�i i ��~''�� `'��� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET ACME To be completed by Applicant: p , - _ v �-,,� Building Site Location: � /��/'�� ��'15� -� l�'�°�����;/ ��'1-- Proposed Improvement:���,,,yt� /i/��� S( �� �� �p����tl.� �,,� �`" Applicant:��La��� ��F�c' "� Tel. No.: l�z> �t/ �"_'��// Address: � Il`� /4,�r,, � ' /-(-r�-7��',l7`7��1 ����j� ;� Date Filed: �� `' r. **If you would like e-mail notifacation of sign o,f�j;please provide e-mail address: Owner Name: �t , � � � � 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, roofng; (3.) If necessary, Title 5 application signed by licensed installer with fee. ..............................................................................................................................................................................................:_......................................................:................:............................................................................................... REVIEWED BY: �f DATE: �'"�/��� , PLEASE NOTE COMMENTS/CON ITIONS: 6" f ��-/�-- � l/h' � _ �rJ ��� _� 7 Northeast dr-Fioor Pian �' s _ _.. ; � ���� �, .�, .:,�._e�°ki°5r�:r„ _ .e � ,. . �, ' . .� # i�bel�tt � t4'x�r _ � } , �� , -,.�� ;_ , � � � ; : � s� � �f t , �. ' .� � . �.»a......�:._ ..,��'"'�.,�..: ,....._�. �_.r.:. _� . . .. . ..m� - �� � .._.�.�.. _.�.,..nv�___e_ .. ._ � �:.w:: �� .{ . . s � � 4 H.:..�j�,�TlB,'�%i!!!�L^�� • .:; . � tGring Aoom � ,e'rct2 � � '�.`�:`F ��` � � � � � � � ��.