HomeMy WebLinkAbout2016 Aug 26 - Sign Off Transmittal Sheet - Front Deck .�� .
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' ,.o��a�,� TOWN OF YARMOUTH
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� ���+��`��.-C+Er4�� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
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I, To be completed by Applicant:
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Building Site Location: 1 � Y"�` � � �`� �Q U '� �����1�� VT �
Proposed Improvement: ��-��►,� -`��-�v�,.� rv�-<- �r� �--� �„1 ��
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APPlicant: C.�-��``'� t„� S �-'�" �, 1 � ll � \ �'Lr�?r't Tel. No.: '�� �- 2 �j �_��'�j'�..
Address: �� � � +� �� �- �, �'�`'���e Filed: �5'��, '► ���
**If you would dike e-mail notifrcation of sign off,please provide e-mail address:
Owner Name:"��U�-C.:� �f�'" �`V� �Cl �
Owner Address: rt \ ; L Y? � � Owner Tel.No.:� � T �"l � �"`��
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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, roofing;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
REVIEWED BY: DATE: �� � � '' � G
PLEASE NOTE
COMMENTS/CONDITIONS:
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LOT N0. : 1 S o ADDRESS: !5��R�NE rZD
df,1NERS NMIE: M�Nl7U2P1
SEWAGE PERMIT N0. : 1t�-9S NEW: REYAIR: '�
DATE ISSiJEll: -�,-� DATE INSTALLED: $''22��`{
IP�STALLERS NAl�: N`'�QIn�cSpc�VJpS�1��L1�re�
5�1: /-3hok l,-6oX
INSTALLATIOM OF: ��x�3�'�lxi O�'r G�
� WATER TABLE: `'-' FINAL INSPECTION BY: PSG�"'�
DRAWING OF I13STALLATION ON REVERSE SIDE:
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