HomeMy WebLinkAbout2017 Dec 15 - Sign-off Transmittal Sheet, Floor Plan� __.r� _,_.. v..x..� � _ __ _ �� .�. _ _� �_
o��Ya� TQWN OF YARMOUTH
• --�:�
�� ;;�rv � HEALTH DEPARTMENT
Y'y :_•.. '`�J�
�"��.�``'f� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
I �y� j ,
Building Site Location: U C ��/���i 2� ���� l�`�ll�� V��P �
�
� Proposed Improvement: U.Se. G r,c,l pCCr�„�,r !'1�c� U „�.►,
,�
,
�t� S PG f-s
APPlicant: �f4 / yv, � 'S �N ��(L�y� ����'�� Tel. No.:��j� �1�` ���Pb
r� v�
�
i
Address: ��� t�u-�7iA �'� ��Yi/1 �/�� �A Date Filed:
**Ifyou would like e-maid notification ofsign off,please provide e-mail address:
Owner Name: `>� (�t��'( P``��� �.'l����3�
Owner Address: �����t ��� � �'�" �����'�'S�1 �u�Owner Tel.No.: �(� � �.Q�(.Q `���
� �
.............................................................................:..............................................:.....................:...........:...........................................................................................�P......!..L�....................................................................................
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, fo include:
(1.) Site Plan showing existing buildings, water line location,
and septic system location;
(2.j Floor plan labeling ALL rooms within building
(all existing 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: /o? 1-S� �
PLEASE NOTE
COMMENTS/CONDITIONS:
�e P/� S �irS�.�Cfi li.� �G� �/.1.��!%�� �
�
�
�
�
� ���� I
�
� , .� �
r� ���� . 1 7� C
1 � .�y �
r
` _
, ,� `! �
a..� G
• . � � G
� w�� i
��,Mt i� O i
R�'"' h a o O G
� � � '
�. o� N Q p ,,
R Q Q
� c �
,.. �
�� � °
� _____
�`,�'"`rt - .� -�~�,
I n�r a
M + �_.
t:
� �
� ' '
.
....��� . ,
�Jo ��y..,�s��. �j 1 � 1...�.' a��o�
Lhfl M • � �e.t � •
s�� �
_ ,
�
'i�.,�ni n�! '
� D 4 O 0 v�
�C �, . �!
'� � , , �,,, . , O �
�•.� -- �
: � � o (�
�+ " �•`,".) y � �
� � I
°7 0
'� � s • 'J z �
� � o
r - . �
w �' ° �
� �.., v �1
'C � ' � - �9
�- � 1� .
, . .
; -, • O
� �
�--- 30. F�oo��- -- '