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HomeMy WebLinkAbout2006 Oct 27 - Sign Off Transmittal Sheet - Front Porch:,. . ;�'_ ,; : .. � <;--�-+��.--�-t-�;�i��-,:�, � �;�`- ,, , ., . ,�°� Y`��o T�QWA1 OF YARMOUTH o ,c� HEA�.TH DEFARTMENT N�„„���,�,�' � `' �' � PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: ' Building Site Location: �� f2f�Sf0 ���J Map No.: DZ�Lot No.: /y T� ( Proposed Improvement: ��0'H✓/ �0i'LC� � �C� �u�fi?r�w� �i`��%-'f.,u�"/Li_ /t.�— o X y —v firaYvi�e.,c.�'',22-�� .�/��;f'/`c-vil . I , / i Applicant: jj�,'�l F C'/�I2.e�.. L.lrvrv.�/t.� 'Tel. No.: 5�o �C�' Z�Z/ � Address: 1� ,�C�v.s'ra 12U�t`.� l�• Y�9��d�r�'� ��- �ZG.��Date Filed: o f _ � � � � � **If}�u would like e-mail noteftcation ofsign off,please provide e-mail address: � � / i Owner Name: /�.1/ �`L�li�f t� G-i n�.�ci�yr./ ; , Owner Address: ��l Z�v�cK/v.�GG. /,`��Rr Owtlet Tel. No.: ��S^'�. f�C�'� � � __._. _._:. _.:::..:...�:U c...r.._.�...r�yc��-��-E'......----,�.�...._._ __f2_Z//---------- , : --� �-�--- � - -� ------�-�--�-�................................................��--�--...._.._.._.-----�-��----�------------------------......_..._._..._... � RESIDENTIAL AND/QR COMMERCTAL��3UILDING � � � I HEALTH DEPARTMENT: Deter�nines Compliance tc�State and Town Re�ulations; i.e.,Requirements j For Septage Disposal and other Public Health Activities. f a ' Please snbmit four(4) copies of plans, to include: ' (1.) Site-Plan showing ezisting buildings,water line lc►cation, ; and septic system location; ' (2.) Floor plan labeling ALL rooms within building (all ezisting and proposed)- � Note:Ftaor plans not required for decks, sheds, w�ndmvs, roofing; ; (3.) If necessary, Titl� 5 application signed by licensed installer � with fee. " ` -------�-------------------------�-----�----------�-�-�----------------�-------------------------------�--......_.-------........-------�-�--------------------------�--��---�---�--......-�----�----------��-�-----------------------�---....-----......_..---------�---......----�--�------------�--------�---------�-�-�------�------�------��- I ` REVIEWED BY: � DATE: l G a��� �' . � � PLEASE I�IOTE � � 1 COI��VVIENT S/CONDITIONS: ` � � � � � i