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HomeMy WebLinkAbout2015 Jul 02 - Sign Off Transmittal Sheet - New Foundation . -�.��-�,��-�.�.-.�.�. ,, . �,,,a . r�, .�� _ -- __ . �� ,�� Y: - .: ...-�-�-.,_-�, � {o���?�, TOWN OF YARMOUTH � -` "-��c� HEALTH DEPARTMENT � ��r�,�6Mek`` � PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be eompleted by Applacant: i A Building Site Location: � , � .��S� �'� �,.G�-�-- � �•..�('+� � �r V�•e,� Proposed Improvement: Y1 e �J ���n � �1�' 1 0 � >. � (V���� �e� �� � � ` , ��CS���t f �.��..9.. �-�' � � � Ap�pp�icant: --�C',J` ��v.Xt-2( S�Le ti"�� } Tel. No.: �b�tJ � �� r � r Address: a> _..l �� b ti'U-- �'� , ��vo ,�k� �,� � l��O L 0 2-- Date Filed: **Ifyou wouldlike e-mail notification ofsign ofJ,please provide e-mail address: �-- J�,�..� ��b7 e- G�+ l70 . (t,�►-- .�.�- -^� ` � Owr�er Name: �m.i� ��J-�`U�.r �o� 1�.t�'�-��-c-� _}.� SS 1 �t } �--c�-e. l,C..� � �t Owner Address: .� � ��Z..t���. �(V�- �� v�v�.��(�� : Owner Tel. No.: uv�4 ��1� � �:�� , ., _. � � C� � � �v U �,.-� ` ��� ......... ................................................................................................................................................................................................................... .:......................................:..............�......................................... RESIDENTIAL AND/OR COMII�RCIAL BUILDING HEALTH DEP�I�TMENT: Determines Compliance to State and Town Regulations; i.e., Requirements ,..', For Septage Disposal and other Public Health Activities. '..+'. .. . � Y. . . � R �y.....,y. . . � j ;'. I� � � Please submit three (3) copi�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)— J�Vote:Fdoor plans not required for d�cks,sheds, windows, roofing; • (3.) If necessary, Title 5 application signed by licensed installer � with fee. ................................................................................................................. ...................................................................... � � � REVIEWED BY: `t CJ �C� DATE: 7 � ,� "`/ S PLEASE NOTE , COMMENTS/CO TIONS: -� u 4� C��� � ��n/ �I'/ S {-�� / Ur/ � �-d Q �-r.�►- c > . � � .r, /�!'D � ird. � �. y,fG�i -y="1/',�G � ? ; � �