HomeMy WebLinkAbout2015 May 18 - Sign Off Transmittal, Floor Plans - New Construction _ �� ___ ___.__ �. �.._- �_�r.TM _ _ �� _�,...�
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�,oF��,,� TOWN OF �YARMOUTH � �,_
- - ,a HEALTH DEPARTMENT
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� ''�-��`'� � PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET !
To be completed by Applicant: �
Building Site Location: � V �l'l5 �CS �/Q/l/�r
Proposed Improvement: /�/ �� � c'N S�� � C--� G�J. �
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CJc��+ � ' Tel. No.: � '' � .�7 Q.� ...
Applicant: � � ��� . �
--� ` , �A� ��
Address: �c(�/� 17� 1� � �,�t /J� v"C�� �z"'r��� G%'2���ate Filed: /Y /`,�
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**Ifyou would dike e-maid notiftcation ofsign o,fJ;please provide e-mail address: �
Owner Name: V�;' � �� � ��v`.c �.�Ptc 'C s�..J
.� 3 2 Ic �-, ' �- /� � 5`�3� � ���s�
Oumer Address: �� � ti 1� C� � � Owner Tel.No.:
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...........................................................................................................................................................................................................................................................................................................................................:......................
RESIDENTIAL AND/OR COMMERCIAL BUILDING
HEALTH DEPARTMENT: Determir�es Compliance to State and Town Regulations; i.e., Requirements
For Septage Disposal and other Public Heaith Activities.
Please submit three (3) copies of plans, to include:
(1.) Site Plan showing egisting 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.
:.......................................................................................................................................................................................................................................................................................................................................................................
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