HomeMy WebLinkAbout2007 Apr 20 - Sign Off Transmittal, Plans - Replace Deck )
TOWN OF YARMOUTH
HEALTH DEPARTMENW,
TTA.P1
\-.Q97YIA• PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: 4c1 a.,c, ct L6a_Li Map No.: Lot No.:
Proposed Improvement: Cc LC. c.ie c K
, )
Applicant L Ha, (c+ +- Tel. C
„4.
Address: e3 C., (C.-(Cit Gt.0 a Lue..1 ), Date Filed: 1-17- 01
Wyou would like e-mail notification of sign off please provide e-mail address:
V4:4°11,
Owner Name: L (.„-t+
Owner Address: Li 6-1C,Lf J-C,((LI GUCLA-
ek I Own&TO No.19 e)c-f 2-
-
/
RESIDENTIAL AND/OR COMMERCIAL BUILDING
HEALTH DEPARTMENT: Determines Compliance to State and To Regulations; i.e., Requirements
For Septage Disposal and other Public Health Activities.
Please submit four(4) copies of plans, to include:
(I.) Site Plan showing existing buildings, water line location,
and kptiesystem location;
(2.) Floor plan labeling ALL rooms within building
(all existing and proposed)—
Note: Floorplan,not required for decks, sheds, windows, roofing;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
REVIEWED BY:A C/O /LL ' DATE: "1 ;10 P'a
PLEASE NOTE
COMMENTS/CONDITIONS:
4
'2` Y
ANO. 3b !1 ,�qq
LOT NU. : L7 C a ADDRESS: �n:(gid, 141
OWNERS NAME: �, IS G k a et f lI
SEWAGE PERMIT NO. : NEW: REPAIR:
DATE ISSUED: Q(,425' DATE INSTALLED: 7/7 7 i
INSTALLERS NAME:
INSTALLATION OF:
WATER TABLE: FINAL INSPECTION BY: KM
DRAWING OF INSTALLATION ON REVERSE SIDE:
D •
ae