HomeMy WebLinkAbout2017 May 30 - Sign Off Transmittal, Plans - Addition - �
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" �o����o TOWN OF YARMOUTH
�, _-_3� HEALTH DEPARTMENT
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��''��=�`��1� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant.•
Building Site Location: �� ���� �� «'�� C� � • �•��V�• l'�-t f4 •
Proposed Improvement: (�j k- �`{ '���t �c'"t� ��- ��c�i--'�-F-(�OGn.�S>
Applicant: �' �`t"`��1�"C. 1�. -�-{c7 l.i`,-'�l_..-'�'j Tel. No.: Sv�' ��' QJ ly cj
Address: �"� 64t-`'��� GN • �G�J� i�, t�-t�- d�63� Date Filed: c�. '3l� a°f�
**If you would like e-mai!notification of sign o,f�;please provide e-mail address: �• E`{O�-�� a-3 �
Owner Name:
� +� �''LC_.c►V CC�wc c�4�,';. ��--
Qwner Address: �� atlt�r-'�J � ���.,,�J C I�.C� !„_= Owner Tel.No.: �� � 6�f, 6�0�7
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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 ezisting and proposed) —
Note:Floor plans not required for decks,sheds, windows,roofang;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
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......... ........ ........................................
REVIEWED BY: ( DATE: �j ',�-ZJ r f 7
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