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HomeMy WebLinkAbout2008 Feb 29 - Sign Off Transmittal Sheet, Floor Plan �,p,. �.-.� .�aEA...,.� ,�_ _ �. ., _�.,. ..�-: �. .�r� �.T .� =r-�.�-�-�:����.�--,, �.-�,.e�--���-� ���. ,.�� � Y � °�� ��o TOWN OF YARMOUTH ; O� � �y+ 1 HEALTH DEPARTMENT I N MATTA M S "� 1 ��"'°"""°`�c� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET � To be completed by Applicant: i i Building Site Location: `"`� `�� '�`'"`G��'` S�" Map No.: Lot No.: � i � Proposed Improvement: tZ�'�Gc�.� � �P�= s�� s���,d 1 r �.�>�s��.,��_ �`�e�.-� �S�-,�,,,I-� FS i ;'�er ��1�ri� � i ; Arrlicant: �..c���.�c� -�-�c J� C �f :S�nG�v Tel. No.: �78 I �7�� -17� 3 � � Address: �� 1�rs�- S�-- �Z , :�Sr�....,F�� Y'`� � d a 32 y Date Filed: ��o�f ac�, ; ; **Ifyou would like e-mail notification ofsign off,please provide e-mail address: 'Sa�C`Y�`i'^�C11t� � ��G+� •Ca� ! Owner Name: C�;; �,�. .� S o � �c�'�r �U�, � (��� ; , i Owner Address: / C� � ��`r�S�~�" ��` i�y���� 5 Owner Tel. No.: ��° "7� I-G�po �sl� ��Z 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. ; j Please submit four (4) copies of plans, to include: (1.) Site Plan showing ezisting buildings, water liae location, � and septic system location; (2.) Floor plan labeling ALL rooms within building (all ezisting and proposed)— Note: Floor plans not required for decks, sheds, windows, roofing; (3.) If necessary, Title 5 application signed by licensed installer - with fee. � --�-------�- - -��...............................................�---...-�-�- �- -.._........ � ..-._...... ....:.............-�-�- - - - - ._._._._........................-�� � ...................... � - -�- -....._............................ ', � �: �� ' �v�wEn BY: na�: �' ; � PLEASE NOTE � CONIlVIENT CONDITIONS: �� / �`� �/ ( I � dl 9 ��N t+� t.cJ��'`-r �j t v f"Q--� � ' Q,�� C� vl`f� �v�'�N c � I a i.�J � �✓t LG � r�✓ Lt.!�'t, C.�,J G�ti V!" i '�,r�P ex.. ' � I � i i � � i 1 i ��„- � „ .. __ -_ _ ---___ _— ---- _�_��� __.� r � r N6 i , X, €`6 Av _:------------ _- ._ ._._ _.. SCALE: DATE: , { r l � 1 I i k• � i I f� 7 1 - t C :Y .1 SCALE: DATE: