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HomeMy WebLinkAboutUntitled of.1(14 TOWN OF YARMOUTH ,y t8 _, _., ' ,..,.... c HEALTH DEPARTMENT . T r �' • ' 1_c1I yk PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: / Y Building Site Location: I V �' 5 ""�'1 s"k L ^• ` .0-,-- "`1 iL . 'e tk Proposed Improvement: Sap+ o�� Qc••r.-t. b 1� T" MS+U- ot - b�►c�n- iD/ r' f? r *.. ur?Gk.,\6 - � P.A..-\, . -<-}Vu' L`o S e ` Applicant: Ni\dx AC Z %IN Tel. No.: 9/61 .1igr'..C.c) Address: 1 d• .Kit.a'(t tae. /n 1.--„rlf11 i?0 -'1 , M h o Z17i Date Filed: i' 1,3. 13 **If you would like e-mail notification of sign off,please provide e-mail address: Ma.,rk 1,1\k.ffS'e Va.1-Noe. (AM Owner Name: kr . 4'1 / Owner Address: 1 N Sa.A d"f s t 4 i,. IQ t-- i- .04k Mft Owner Tel. No.: /Q L •7' C '.1.5``g- 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: RFCo/ (1.) Site Plan showing existing buildings,water line location, 413p ito and septic system location; , 1 75?0?,9 (2.) Floor plan labeling ALL rooms within building y (all existing and proposed) — 40Fioj, 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: J - / c 'c7,Z,3 PLEASE NOTE COMMENTS/CONDITIONS: H 7 O t,/, °1 )-i II ) 1 \ O rX rk II m 1--4 m 1"1 \*/ , 2 . cA n v) oz rri CI m r y O b a b z r a z o_-* ' , • • 00I, k • t- ® .i- \ r- i, ..... C: ,, 2 ; g \ „ e4 t>7 co /77 to i :•I I 1, T' \ / cs 0 0 a III O s v) ....._ I 0 .., I__„--,,,r O ! , a z o i1 ,,, 1 9 1 No i 1 \ , Cu` 1 � � R z „ ° 1 1 5, it R111 I r E 1 l Ia' , = ir , . „ , ., .k.9 © ��hq F--. .� ' ME 5 l N H - ©I© © ©, Ay © 4 . P rg � � 7 p0, I • i • 1112 1 0, "- I tang o MI = - Y v IP' *9 �S- 4- ---- "boo ill ———— :m r P i I / �J C- ; ...r- ' . . . f. .c �7ph.li .$c,c e* • 1 IliIII 1- a O 0 •► w 10:000 F w A Wo °Pil, A'A _ ; \ a., 8 itr il ?e, - pp • i r 7 lk :4_1 • k 0 ci z rn co m o < c :° F. c 0 1 q 111 1 k 0 • o Q ° ss�e° A. g I 0 CC J V� `Oo 8g 1114��ro ry ;I. O �k * _ o *111 14 ' Z e.3$ati,.! w U)p r W:�on� Ei'd- _ (�`, R ? ; ~C Y 3 i3O 1 w $2 Ell a % gw3 $5 e4C; 0 CC Q < d i s Z } < "y '"a a 8a il i ll ii a �1a < i� goo s, il ,1 ag2-m # ^ 0f I I 6 t:>-'_,.,___7 j"'' ,5,(\--r:11 GI c1- e0 S, 'f(, A - ;1�� o I % ...._J..__2), �Vo 8 ,..rj Th.______,k ...1 1 \ \ 0 • ¶7L :z::(I1, \ \ 1 1 it � ►, \ \ S. J < 11 it,,, i.:!,,I, i,viim..., -7)''''''',6; ...."-1 Sa# 22 1 4°,tN , h abb, lt 1 .Acili'L'' zoa=� s __I dr(r- 1 , 9 1`hl ems. , ' rll,_ y ^ \y,,i/t_�' ,' O Y , 4 Nn IN/ 'ti il* 0' 4n N V 0 . i