HomeMy WebLinkAbout2008 Aug 25 - Sign Off Transmittal Sheet, Floor PlanTo be completed by Applicant:
i
Building Site Location: S
TOWN OF YARMOUTH
HEALTH DEPARTMENT
PERMIT APPLICATION SI(1.FF TRANSMITTAL SHEET
J,,IV-/W YT, J', Y&I# QUT/��` Map No.: Lot No.:
Proposed Improvement: (911" 9 S T.S &0 '9& 15,700-I.S // ✓l/l!%/�G'
Applicant:
Tel. No.: 5? 09-j Fo" y3 C15
Address: /o /vl�`✓� s' 6 � ✓3, �/q,��rlvt�T� Date Filed: 9rO� S�'0
**lfyou would like e-mail notification of sign off, please provide e-mail address:
r
Owner Name
Owner Address: Cox :3 170 5. ,/f efil oUi-/4 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 four (4) copies of plans, to include:
(L) Site Plan showing existing buildings, water line location,
and septic system location;
(2.) 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:
PLEASE NOTE
COMMENTSS/CQNDITIONS:
,J
�,Z)J. 10Y� c/,;-
LeinI^,� �t fa� �i
clu
0
cl-j
CD
Fq
Lo
[E
()oCd
0
0.4
o
c
II II
"►�0Q
�lpjd ZB7oq�