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HomeMy WebLinkAbout2016 Apr 01 - Sign Off Transmittal Sheet, Floor Plan ,_. .,.�,�. _. ._..._ _._.�..� � �_� .��.�-. . �:_.,_.��.�. _ _ . 1 7C� . d� . .. . - , ' ' .. .. f .. . :.< :� . . . � 'i ' � J _�__... �. .�t�', � I t _ _ 8 ,.:«� i ,oF��,� TOWN OF Y�MOUTH � �� � ���� HE#�LTH DEPARTMENT � o�� �� /'� , � 4''���%.T PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be complet�+by Applicant: :.. � / Building Site Location: �Z� �j/1 G► +°1 � � � � �� t� vr r�b t�fh � O Z.b 3 . Proposed Improvement: ,n p -��: � / f� `�'� �r^ , p) #� y '�vE'iT�F�7' " 7 !O +/�� !: 1...�t t �S f.l " �� " F <�i fiF ."�,t �.+ ( .� a Lv'."� J { t�L _ G�� �..yF �t:. ;��.�� ..������ . . � �� Applicant: l� � � � � Tel.No.: l,'�j� "7�� g� �Q . Address:} �t1' ���f��-� (��V�;y���,��j���j� Date Filed: '� —'ZZ—�'o��, � _ '""��' -~C' ���G���!.�"�: �� + ., _.----=`'��. **Ifyou would like e-r�ail notiftcation ofst�t�,j,�'s��f�a��o��y�il addr.�as: i �_� `����� '� a� ,� "�'` r s'�` t ^�� f"� ;� Owner Name: . , � � ��. ��� .>� � � —a �' .,�_�r—,,�+ �"� { , �-��-'.�r' � � - � f '".. :( �n��'. .:Y 4.... .��L�'�� r 7�.{� . ' —�.�.�_,_�.�..�..'.�`,.:. '"'�Owner Address: 'j �� ��t,/'� ��=� �S'�a� Owner Tel.No.: Z��'�--- � � ........................:.............. ...............�..:...................4�-�7.7.�........... ..:......................................:._ .... �f ................ .. ..... ti ..,�...� �, .................................................. ..,........: ....... � r�� �.� RESIDENTIAL AND/OR CO E C�BUILDING , ` �; � f HEALTH DEPARTMENT: Deterrnines Compliance to State and Tau�n�e�ulations; i.e., Requirements y For Septa.ge Disposal and other Public I-�`�alth Activities. � . .�!� .. � . . � 5 A 9 . . � �.. S . . . Please submit three (3) cop�ies of plans, to include: ` (l.) Site Plan showing exis�in�.builc�i�gs,water line location, a d ' ystem location; �ti � �2 %� an labeling ALL�boms within building � �,� , ,. , `� � gisting and proposed)— ` ..1�f �.+� . �� Note:Floor plans not required for decks,sheds, windows,roofing; (3.) If necessary, �itle 5 application signed by licensed installer with fee. � .................................................................................................................................................. a .................. :................................................................................................................._......:.....:.............................:....................:.......... , REVIEWED BY: ' DATE: � ` � " I � ��' � PLEASE NOTE COMMENTS/CO DITIO S: ,/�� y9� l �'1 v� �-�-- � � �U(2.. ln t � �_�µ c�t., t �• �s� t� � , � a i ..' � � .� , f � . . ��oQR n��►t.l - "j�"A s 'rY �u���`� . _ - �� S�'Pt"�'f`h'1G ��g�}Lt-�`( � ' �x�r PI 2� � ---� �3-' � 8 .�_ ; � � ;U� _�(�� � C_ �1� . � � p ,�p p `� b � � _=- _ �Q CQC�.- � -���AL- �� c�. �L ta .' � - - ' K 1'�G� �h� '� R O O � ��' � - Qf��� �1•� C� �� O _ ` p� ... p � ' � ::Q O a ' , . , . �- _ . I p � � D j tioaR - -. �--- 4 � D oaQ - t3 • � `�- � 6 Iwa me�v'S � � � �Y � - F : � � (�oom � t3 � �� ��5� U {� i. • � s , ... . . � � (3 3 f� � i� v v J Mt�S �� � � - �• � , ► � � t • t Rovr1 �� ; ' � � - E� RA r�� _ i . . , S�A�RS �� • o o � . � a b�a . � o o n o a o. ���CE . .. .. ! � ��s 1� ���3y �' RAm� � � ° RA�,p c o '°'' �° a c� o �o O L� o u �o o n a� o O 0 0 -�' "o a u vo � o � �o • 0o uu o0 00 �5i fl � �• o a o � o o� ' � o 0 0 0 a `a '� uo 0 0 � au � . ,.�.. a000n oL � ' ° d � av oo an o000 3� o. ' (y O O O O O (". . p-� ^ � i�.A�+�+� RA��np " "`' ; ' • � ,; i • . � EMkRG�o`t ut�t ; `_�._ 25� __Ex�T --- _.._.._ ____--_- t -_.__._._._____ � _ ---- 3S' � � � � � o � �- E 2 �r � y� - � � � � r �