HomeMy WebLinkAbout2017 July 19 - Sign Off Transmittal, Plans - Interior Improvements .�3-.,�.��
�-�----�--- . � �.�.�r�,��-�-�— _ _
-� --�--� ____._ . .T. _ �.,
� �--���•�:
,�
..oti-''rak TOWN OF YARMOUTH
.�-�.�
�� - �-° HEALTH DEPARTMENT
o:_�.. �. ��
��'' ``��� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
r`���vME''' � �
�'o be completed by Applicant:
Building Site Location: � �R� ��A ���� " IA'1� v��—�'
i`° �
Prbposed I � rovement: v-�,,� � �.,,•�r�S '(� �--t`+c.��,J
.?-,,,�� �I;�P-uu,.- �r� n '"' �rnrc�i.r S -- c,.v ,c 1fc)C'i�+n '
v� a v (Z.•
, , �;
..--__=.
Applicant: (r�►�c2 Q/ TeL No.:-J t��s,'1?l�, .h�2�—
Address: �� ��� �� �Y pZ-(v(o� Date Filed: '� 1 1 t"Z
�
**If you would like e-mail notification of sign o�;please provide e-mail address:{'�/�CU�1/�G!►� S�n S ►Yl G� f�M14!t C,•LvM
Owner Name: �1 .�4- � a� �N S
/J r----
Owner Address: Jr'�}� �r�-'s'� �`'� �� Owner Tel. No.:
..............................................................................:........................:...................................................................................................................................:........................................................:..:....................................................:.....
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 butlding
� (all existi�ng and proposed) —
Note:Floor plans not required for decks,sheds, windows, roofing;
(3.) If necessary, Title 5 application signed by licensed installer
with fee. ;
..................................................................................................................................................................... .........................................................................................:........................ ............................................................................ .
REVIEWED BY: DATE: �
PLEASE NOTE
COMMENTS/CONDITIONS: '�;�,.,
v c� ' , � 7'b ���� `�- � `a' ' '
�
� � r ��� �
l u'' � , c' F-- �cr�-�` � r v�oc,�'
�