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Home My WebLink About2016 Apr 04 - Sign Off Transmittal - Demolish Portions of House x� -- �� o!�_'�a� TOWN OF YARMOUTH . .,,,,,�,,y, �'� M -�� HEALTH DEPARTMENT �C` v r� ky�'"� . . . . ��-' PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: Buildin Site Location: `T�j 1 � �� M IMt�tr�� g Proposed Improvement: v \� �1 ' S U l,��-S� '`� 7� �S�= 16�� Applicant: ��C l.5�6 > L� � � . � Tel. No.: � Address: a-G`�l C't � �a r�h ,�`1� ��'�i Date Filed: **Ifyou would like e-maid notificatdon ofsign off,please provide e-mail address: G(�-'h ��, {'�S� ,�� r')"` Owner Name: \ ( � -�-- �G-�S S i._-l�-C, Owner Address: c U '�' UY-�• �"` ��(S' Owner Tel.No.: ............`.f...�..�...................:...:��.r�...:...t..:c�................�..�-..................'��.�. ...��a..�.... ...�_�....................�.�-:-...�..t.o..........................:......................................:........ . , . . 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, roo�ng; (3.) If necessary, Title 5 application signed by licensed installer with fee. ................................................................................................................................................................................................................................................................................:....................................................................................... REVIEWED BY: C (J DATE: '7�'�l� PLEASE NOTE C�S�`i S/CONDITjO cS: � � �� G;�-�4,� �GC �l� . - �/�C / - •�'� . s � � � ��f�-,� �'t��E��"' � : -�� - � ��.��-+�� ..�� ... �'�'� t' �. ��-c�-c5' � � �%��:�t��''-ic �..t�c"��'�'� . - �� i � . . . . � � . �. . . . � . . . . . � � � . . . . . � V' �. : . . .. . . � � 1 .. . . .. . . . . . . . . . . � �� ..� � � � � . �� . � .. : . � ... ._ . . � . . .. � . �"' .� . . . . L \ � . . . . . . .t . � �r`�a 5 -�e �n�o ll � �.. . � � � _ _._�� .�� _ �-�� .� ��. �-�� 4r�-� �n , �� t � � � � � � __ �`—�� — _^ .�_ .. �` , _ � �� ; � � � f � �.�: � � � � � � _ � � _� � s � �. �:.... _.... , ; �� r � � � � ; � �� : � � { : � . � _ _,� : a.,....,, � �. �� ' ,��c�� : ��"`` ��i�� tt��'�``��'""'"` � ��. � � �� __. ��___ � ��_��