HomeMy WebLinkAbout2015 Dec 03 - Sign Off Transmittal Sheet, Plans - New 2BR House �o�'��R,y, TOWN OF YARMOUTH
�� M -p.w-���� HEALTH DEPARTMENT
�
� "'����E`'� � PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: ��+ ���G� 5 Yf�1�'
Proposed Improvement: ��_'U/ �D✓15T�v�?v o'� ' ���/��� � �ep���L��
�
��
Applicant:���i �'JU N�'7', �v+ �- Tel. No.: 5a�.7��b .(�0�- s�
Address: f�• 4� �jv K (�r�� �pti'i?� �/?12l1,� �� Date Filed: (2- � t �
**If you would like e-mail notification of sign off,please provide e-mail address: ot�2�.St�Y�-`J' �K G (�5�('�'"/L.�'t.�M
Owner Name: ��"1 vN�•^"'
Owner Address: �� ��p+ S l�"c"1CT Owner Tel.No.: �
..................................................................................................................................................................................................:..........................................................................................................................................................:....
RESIDENTIAL AND/OR COMII�RCIAL 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, roofing;
(3.) If necessary, Title 5 applieation signed by licensed installer
with fee.
.................................................................................................................................................:......................................:...............................................................................................................................................................................
REVIEWED BY: (� DATE: � Z '�j '"/�
PLEASE NOTE
COMMENTS/CONDI IONS:
- — / .
♦
/ '�
£'G
Cl' ' . �' rr.
,z . i��`�Cd� ��cf. �,�� -� c,
3 . y s ���`��
���� � � �
�
_ :., ___�_,._ :a�.._._
.:: , ..
,,
.. � .�
.: -.
�. .
{ �
{
t
.- _ .. - � :. _ t ... ... � ....... _._. .. - _ -. ..1. _ _ _. .... .5.�. � i
_. . , � j
4 � 1
.. ._
1 �
...
3
... .. .2 � . , F: .
f _�' E �. v
-� � - � �. .
' v ... _ ..
t
i. f �. _ _
.. .. - !
4
-
r
{
1
i l
r
y
I
.tom
f }
, ,
g