HomeMy WebLinkAbout2019 Mar 13 - Sign Off Transmittal, Floor Plans RE(aEGWEDD
TOWN OF YARMOUTH
4ift'4 ° HEALTH DEPARTMENT MA tl 1019
HEALTH DEPT.
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHE i
To be completed by Applicant:
Building Site Location: j - Y't tack_ W • y hko (iAIt.. 02.6 7
Proposed Improvement: R2 -rt.. tI-CV\ 6,e42_, • asst A
- 1 44_t �sc�_, r. — O - am tips
fZoc
Applicant: 6 51 w fC Tel. No.: o ej C( ,(3 C
Address: yt�7( 7)/ c Date Filed: 3- 7- I '
**If you would like e-mail notification ofsign off please providee-mailaddress:
Owner Name: l c�'1 Kari 41- 3,—v- i G ,t,S
Owner Address: ( Owner Tel. No.:
l AIL6 � zz
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 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: 3 i/ 3 (`
t�
PLEASE NOTE
COMMENTS/CONDITIONS: t
`� C c‹-s-e a �� � 1`a-.�t ` 12-tm
rk
r1
uncicje- IC:/0c/ r-)6vL ' 3/1 )/ ' oto
9'/: ' A R/E.....A
AREA ' 16 , 800p
_...,,3,
� � ? 1. 1 - '''::_t;lilL'ill..-i.. _ ,'
n..
.
f 704
::::::,,:l•:-'
� / \
\-7-0r--- //
..
/
...
•
MN• -• 111.fr. -- 1"' ;,--,-----.—.;::-
do, _ N,,, ..
V(..\
� ... , k \
9 o
\\ x's .\ .. .,4.,../i Z
'l' `� \
/7/
t..t / .... . >
.•• -�� ` �
//
Qp,Xtro Sr
/ R CE-WED 4 X. ,
MAR i 3 2
i�- ala-. .,. - •, ..
8
-r 7 fl
k
x �
. s'"..,�' � PAY.
�'�• .
i m
ac
i�- ala-. .,. - •, ..
8