HomeMy WebLinkAbout2016 May 23 - Sign Off Transmittal Sheet - Raze Existing Building � �.t n
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.�!�-'Y'�'� TOWN OF YARMOUTH
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���'' k�`f� pERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
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To be completed by Applicant:
Building Site Location: � " � ; ��;����-�1V1 fl
Proposed Improvement: �. �jGl�?�� �Z � "("p R'�. ,�, �
Applicant• ';-•'i ����...��� 1►�t�•.,i Tel. No.�?J'"?f�"'1�^2�:'` '"
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Address:�,✓'� e` ,,.�art�t���'��'��;.`,f'�rr�•,',,�.����'=� Date Filed: x` !�
**Ifyou would like e-mail notification ofsign off,pdease provide e-mail address: ��' �������;��� �
Owner Name: '
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� Owner Address��� � �� �
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^`'� RESIDENTIAL AND/OR COMMERCIAL BUILDING
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HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements ' '
For Septage Disposal and other Public Health Activities.
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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 � i
(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.
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REVIEWED BY: �1(�L����D DATE: �� �-�-,�- —/ i
PLEASE NOTE ��
COMMENTS/CONDITI NS: � � i
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