HomeMy WebLinkAbout2022 Sign off Transmittal - Deck Replacement r
TOWN OF YARMOUTH
HEALTH DEPARTMENT
Ir.
` Iri
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant:
Building Site Location: `� )`02r LJ , 1L 0 `'r1 ij,VIU UH ,j 'L,i?l 02C1
n �
Proposed Improvement: x C"�t2\c 2 Deet- 2E 1-1 I9 cLi-Yl t -c 16 >C ?'c)
ELL-L'ikflc ry - i a)S c21 ( JU 4C.1(.,1
Applicant: L01_0,1/4.) >Yl \w (Cts e- ' , ►'i' LONJ Tel. No.: CuL'i� -2`'t Z l
07y
Address: '-try,Z- ri`' C 12 `" C-11 VA)‘A Date Filed: 7 (
**/fyou would like e-mail notification of sign off please provide e-mail address:
Owner Name: ( E,L.Q 1
Owner Address: CoA -&( Y2i) c ALi 0ot4 Owner Tel. No.: ({ 12 tia 6 I
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 necessaryy,,Tirtle 5 applicationsignekby licensed'inrstaller
with fee.
REVIEWED BY: ( DATE: c-z//
PLEASE NOTE
COMMENTS/CONDITIONS:
INSTALLATION OF:
WATER TABLE: FINAL INSPECTI®N'E:
DRAWING CF INSTALLATION ON REVERSE SIDE':
a �4`
L-°
ow
m
--�rq
r.
t
rrTbutfi,& c
co I .. . ... j.
Lillie
I1 lIi„c:
It
C.
C
if' 1j
JIV
..I.l Al Il J
CT rH
; 7-1—
�;4
44,1
NG
F
SP
I - •.: SITE PLAW
4TEf7 ON N V.
THE% V., I I
LOC S�
4 N I u
9:47
E301 0A ra I, -J1
44
JQ0
TU
REF: Etngja
—
vgq(?4?rq?§ 1, ? 1. 1 ":'1 . , UI2II 1i , I I . I P-1- % Ni
ee 1 PREPARED FOR”
1.V1L`.,ENG1NEERS
AND SURVEYORS
REG. LAND SURVEYOR
SCALE
ins MAR ::FTIir
DATE
AA
%
tic
71
;'3
14.
vf�
Alike'-
I.I
t
rrTbutfi,& c
co I .. . ... j.
Lillie
I1 lIi„c:
It
C.
C
if' 1j
JIV
..I.l Al Il J
CT rH
; 7-1—
�;4
44,1
NG
F
SP
I - •.: SITE PLAW
4TEf7 ON N V.
THE% V., I I
LOC S�
4 N I u
9:47
E301 0A ra I, -J1
44
JQ0
TU
REF: Etngja
—
vgq(?4?rq?§ 1, ? 1. 1 ":'1 . , UI2II 1i , I I . I P-1- % Ni
ee 1 PREPARED FOR”
1.V1L`.,ENG1NEERS
AND SURVEYORS
REG. LAND SURVEYOR
SCALE
ins MAR ::FTIir
DATE
I
AA
%
tic
71
;'3
14.
I
%
tic
71
;'3
14.
vf�
%
71
vf�