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HomeMy WebLinkAbout2017 Jun 29 - Sign Off Transmittal, Floor Plan Showing Repairs -�-.�--_.- . P. .��,;,�,,.�._ � _ � � � � o�'Ya� TOWN OF YARMOUTH � ,..�.� �� �� �X�- � � HEALTH DEPARTMENT � o:.�.�.,. =a � ,� � � �� �- ,���r ''��E-`' PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant.• �; Building Site Location: �� �17�'�y'� �- Proposed Improvement: �NAlNl�' �/X� 0�"� ,�2f�. SL.�QC7�, G�s��{ ��ZFS .��'�'� �/ld�Nf) . vy. Applicant: �l �.J Gd� Tel.No.: �J � � �� -��'a Address: �a �O��i� � - �- ,�(7�c.0'1��/tt Date Filed: (? �l !� **Ifyou would like e-mail notiftcation ofsign off,please provide e-mail address: OwnerName:s� liL.,�9G� �..,...•�''""" Owner Address: �� ����L L�GjL� /�• Owner Tel.No.: ,��- ��,3 :,3Ge�0 o a33� ......................:............�.�.......��...�%�C�.�.............��...................... ............. .........................................................:�....................................................: ................................................................... RESIDENTIAL AND/OR COMMERCIAL BUILDING HEALT��PARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements For Septa.ge Disposal and other Public Health Activities. �t� ` 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 (atl existing and proposed)= Noter Floor ptans not required for decks,sheds, windows, roofing; (3.) If oecessary, Title 5 application signed by licensed installer with fee. .............................................................................................. .....................................:.......:.......................................................:.......................................................................:...... ........................... .................................................. REVIEWED BY: DATE: � � PLEASE NOTE COMMENTS/CONDITIONS: �, f e. e "' . � � � � � � � � R� �, : .� � � � � m•�,.��:�z _ � � d y —� � � �' � m `�' �\' --� � � °' t, � � � � �,R � m s � : '� � � ��_- • � � d � � � �� . � � � � 1R4' � �� 4'6�(�) �� b � m � � � �i� .�. '�.. � � � z � ; � e oo �, '^ � a 4 N �, � �V 6! _ � "• • rT 'q � a � � � � � � Z � ; � �► � N � , , Y � � � ra-r ra ,� c.tr . � rr-s- r r.+.�. � �� 93 T- Q ' d' 6.9 3'A'--�' . , w � $ a � � � ��C' v T� 9 � � �t ; v�, e a' � � t �S`. rT }� � e � O � ; � �j �' �R �ji�` � m � a �;$ i �?� � . � � v �i c� � � `:� �" � � �..e � �� � � . .�. ��.�. '$ co G� � ��• � � � �s ; � � �.� Y zs-0-- � ��w � � ti �r � :� ,�c� �, �� .� �� �� L `"� � "1 2 � o � � .� � � m ����7 � �} � R 1" r �~ � G � � _ ����' t� �,. � N�`�Q `'> ��� 0 I __ i __ _- __ - ------- I i � I ; � C I