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HomeMy WebLinkAbout2017 Feb 07 - Sign Off Transmittal, Plans - Addition of 3rd Bedroom � o:,.., _ .. �,� .; t' �9 �,,,,_. � � ��� ,..,:� o-Y � TOW� OF YARMOUTH � -,�".�.� �r :�+`-';c HEALTH DEPARTMENT 0:..,��:� _��i-i � � � �,,��j r,.. t�.l�'�' �E PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: Building Site Location: ZsZ G�-'��� GU�S%E��/ ,�D•� S ..t"�• �i�-/-?�C>C�Tfj� , A � Proposed Improvement: �UL.L. �'C'1U/�.I�.�T7'4�,1� /I'?9,.,57�..,� /�3�,�/Zpp��.8�-�t i .4DDi77G� j , Applicant: �/E�',�Y .f� �9-��iy 7"'}�i(,lT���-�-- Tel. No.:S48 89�c ZCo7.�-S S�S .3,3 c� 34 7 Z Address: ZC>� Cf�GLc ,�i�T� D,�'. �3,�/=�✓,�,,T;�"'a�,-' Date Filed: � "7-- � � * **If you would like e-mail notificatio�o,f sign off','please provide e-mail address: �a`��a�'� y4�!'100 •GO M � � Owner Name: ,.5f}rI'I,� i Owner Address: �'`�".�`"l'7� Owner Tel. No.: S'/'-j-�-Yl,� , ' ...........:........................................................................................................................................................ ................................................................................................................................................................:............................. 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: (l.) Site Plan showing existing buildings, water line location, and septic system location; (2.) Floor plan labeling ALL rooms within building (all existing and proposed) — No�e:Floor plans not required for decks,sheds, windows, roofing; (3.) If necessary, Title 5 application signed by licensed installer with fee. ............................................................................ ................................................................................... ............................................................................................................................:................................................................. REVIEWED BY: DATE: � � � t � PLEASE NOTE COMMENTS/CONDITIONS• r vC/�� ..�'�7 � V 4�'/�"1 i __. _ _ r _ _ _ � ; i i i � � ; i �, ' � �. TOWH OF DENHIS j , , � I � 1 _ _; � �� � � � � � �� ,. , � ; , . . � �. , ,. _ _ _ � .,_ , __ , _ -� . `�� _ � �- , � � ���, . . ; ___ _ , � � ' `` ; ;; i ' ------_ , �__- -_,} �; i /� / , � � / i� i � i� ( �, ���_ i ,i � I -.�.____ _�pss � j � --___ - � ,� ; ; ��G � , , ��� , , �� ��Y�,��, �` `�, , � � ,.�2,� �� P�o�dz-a� - . �' -- \ 7nc q� �,�`� � - - avservannnr �\ �s , I �"" \ \ .1.- A I ia \ � ,i.sa ac � I I !r/ n� �,,;`,�; � , L�; i��, � ;' i 1 ' �� � �,��. rl�p�t8t '�� � � � _? � 1 �- �� `, _.._...�. (✓ ,75�,,, � i � r � , ...— -. �-- � ./f� /_.i�-- \� � , .- I �' 6 I ��� � ur�� � 1 �.se nc i ,a ' ' a.ss�nc ' �1 .a9 nc ,-n� �� , � � � �� , � � � _ _ __�- ,,.. i -,;'%..� `; I 4 � '`� �__ ___ - � �-- �' 3 \ __...P/0101-�182 It 7.40� �� �$ ROA� � \\�\ I � 9 � � `9a I � " ` ��sM � � \ ; I Z l� 4� ��O . nc \.. �\ �, � � V .as nc .zs n� N`GN�PNK asz .. mwx�va�ormr' ��\ i � 10 � I �,, 407� .71 AC 243 AC '�.� i Pro sz-s '�, � � .92 8P/O 91-��.. � � N�LBURPARIC �. ; 6 ', ' - - - - - - -� - - - � �:,.._ - - -- -�--- - - -- - ----wo�oz-s - - - � �- - - -�-- - - -o_.e�nc_ —'�= — ,�ae ;rio sz-s s �" wo�os-e ��_.._�! P/0 92-8 � /M6l/BAHR � . EGEND 7� formation Shown Hereon is for Assessing ._.�.-.�.� ....�.� n�i�T�ro s ouv. wh�H OAO a��r.,,,�c nnlv_ No Liabilitv for Error , � � �� o/ � - LOT`. N0. :��ADDRESS:��oZ, Grc,a.�.l��e.�',y,-,,r' 20 � w OWNERS NAP(E: �� �r.v . � � 4 SEWAGE PERMIT NO. :D`��?�NEW;�.REFAIR:� ; DATE ISSUEll:�=_D�TE INSTALLED: � . � , Ir�STAI,LERS.NAME; J d`� �,� .� � ` INSTALLATIOPI OF: /�� („�l ��1a� w WATER`�=TABLE: ����FINAL INSPECTION By: � � � //�/ I __.DkAWING OF INSTALLATIflN ON � REVERSE SIDE: i -�� . � I i - i i ��1 h V��� =J + _ , � ' O ,�,��-- ' A�IU I= 3 s�°� �.�,�K �I G �� Q�io 1- q'g'' . . � . , � $so�c =;�.1��� . : � ��vT 3�a- �3 . , � . ; �.T a�,ot��. � �x ��. ��. . - � i ��°a` �,� � : � _� . . �. � . _ . ��. c� S'�=�'�s �. 3�'xa'xa' � - v�r � L m i N — rimae f �o 117 OWNER.T4�TFF a/LA,�ZtII! T NOt��G ADDRESS 'Z G,��AT ;'�T GR+V X20 So,ezfto U7 N A� SCALE F.D. CIAMBRIELLO� RESIDENTIAL 4 COMMERCIAL DESIGN DRAWN DIE i phi REV FG o o!Z G04Al DWG. NO. or4