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2017 Mar 22 - Sign Off Transmittal, Floor Plan - Basement Renovation
_ _ ^K �.H4----��-- .,o�=Y�� TOWN OF YARMOUTH ��� �; ;;�- ;� HEALTH DEPARTMENT o..� � �r-f-� � � ���''� � `���(x PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET �� To be completed by Applicant: Building Site Location: � j O�� 5T 5 � � �i`Y' v�� J' ., Proposed Improvement: r 1 C' G J G��/C �Q�� �" `� ���l�G' t�1 t¢ y'�` �`d ��� t�'�'7 � � �,1 r� O D 1-'�) / � �' �=� ( � -� � — �=�x ��''r'1 �� c-�xt ��— !�t � ?� "% ��c_� C �GS-�'"�"` APPlicant: G%/ 1) "y CJ Tel. No.:,�6� �c/�S L��J 15 �, � Address: ,��j ,�PCt C'U���� S`� J, � G��t-1 I G �=' � � r Date Filed: � �_ / `-� **If you woudd dike e-mail notification of sign off,please provide e-mail address: f 7��/%`' !^ u� `^f` Y�/G r '• C a►'r-t Owner Name: � ' 1 L. � �" U l "� Owner Address: ,J Q y� � � , ��-t���l �Owner Tel. No.: J���;�%��/Sf -C�' ...............................................................................................................................................................................................................................................................................................................:.................................................. 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 egisting 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: �� �� PLEASE NOTE COMMENTS/CONDITIONS: . . . . .� -� � 3:�c :3t ^! ' .. . . 3i < �� ��, �� ��j � x �.��.rj ' ; . : �V t K�4LRJ. . . . . . _ k.i l rL . ttj . ,-JR1JtV L `?�t�.�.�.��,� . . . . . _ . . . . _ � : _ . . _ . . /� . . . . : � . . . . . : . . : . . . . � . . � a�-.�, - . . . . . . . . . . . . . . . . . . 1 . . �' . . . . . . . . . . : �iA�� �1�nc��++� �,l��t.�. . . . . ...... � . . : . . . . . . . . � . . . . . . . . � � � �, -� . �°. < <,. . � . . . . . . . : �. � : . : : - � :` � . � � � .�� _ � . . . . . . : o . . . . . . . �}. � . . . . . �� �, � � . . . . . . . . . . . . . . ^ � _ . . . . . _ 3z . . . . . � s ��-� � . � � . . �k . . . . .� . . . � . . . . . . �� � . . . . . .s . . . . . . . .o . . �. . . . . . ��, . . . Q : .�, � . . . : . . : . . . . c � . . . . . . _ _ . . . . . . . . . . : . . . . . - ~� . . ; �,l�-.w���4:� L— "(�.�� c�� 1�► . : . . . _ . . . �'�' .�� . . : � � � . . . . . . . . : . . : - �: . . . . . . . . . . : . . . - - - : . ; . . o� � . . . � � .�,.� � ��. � � . . . . . . � . . : .v.��,, . . . . . _ . . . , . . . : �: . . . . . . . . . . . . - . . . . . . � � . : . . : . . 5-�-�-��. . . . . �. . . . : � : : . . . ; . : . ,,��, . : . . . . � . . � � . . : � : : : : : : : � : � : �.�f : : : � : : . � . . . : ' . F . I�: �'�. i . . : : : : _ : `: : : : ��� : ` : . : : : : : : . . � : , . : . . _ . . - : : : - . : - - . : � . � : . : _ : : . � �3�5_ :s �-� � ; . . . . . . . . . . � � . . . . . . - - - . . . _ : . . . : . . . . . . __ _ - . . . , . . . . . . . . _ _ . . . . _ . , . . � : . . ; . - . . . . . ; __ . _ : . _ : _ � ,. . : : ; . . _ . . � RECEIVEQ ..._ - � : � � : . _ . _ _. . ._ ._ � __.__ . �. . - - _ . . ..- . .. . � MAR 222017 ' . . - - - ; . . . . .. _� , . . . . . . . • • � �- - � . : .� _ .. i ,�. � - . - • � HEALTH DEPT. • . . _ . � : � _ ��-- ° + - • - -- � ;.. � .n. -. ' - .: . , � . - -- . � - :- � c�.`. f'''�: �91 = . . . � . . ,� i c5 BE�o1� _` ; � � � � � � t� V;o►��' . , � . . � � �2cz Pc�� t�ci5 ; ' � . - : I . ^ . _. . . . : � : . . .. . .. . . _�� � ' S�' � � Y�r�� � � � � � � . �� �� ►���� . �s�u: - - � � - : .