HomeMy WebLinkAboutBuilding Sign Off -Garage Conversion ...0*Y` 4 TOWN OF YARMOUTH
c HEALTH DEPARTMENT
o * H
••*4 HATTA cs
_ PERMIT APP
LICATION PLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: / r /Zv w E S%orti a Map No.: Lot No.:
Proposed Improvement: S'U,,,op i,r.v A C Lu cPT A4,v 1-77?),i1 S "i-779 /7/J 6 e /V iU0
db>>t6 /m ;uiv -/4t 6/. ,L,/6C fait 1 /4/Sir/ 'A
I '
Applicant: Z:1)04 461 S' Tel. No.: j - 7,2/
Address: /$ "v/L-e S2-ort, /20.9 D` .j yi x",/eY1 j eg g Date Filed: // ) '
**If you would like e-mail notification of sign off please provide e-mail address:
Owner Name: S 2rn
Owner Address: 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:
(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,lAwds, windows, roofing;
(3.) If necessary, Title 5 application egled by licensed installer
with fee. °
REVIEWED BY: DATE: ///a S-f/o�•
PLEASE NOTE
COMMENTS/CONDITIONS:
54cp fr-1G7, To be. us.- cbl QS AG� vo .
PRo poses C. ka,)ce ( tis ►-N.,,3 Saw. F007 ?R►4
t 74g4 si (---- E'4a --- P.I 3011 1 < 7`I" ----.>1 '
LoL
Li
�, I •
^' LaUU�,�'�y 1Zoc,tvn. 1\tip/
strop gi €
ti,34aion\AO°S' '' i- -
_
15 RuMe S onie ko21
0`) Are °off'
‘%.0
..-..r.f.!-• f
..,
Ste p G313@glIV D
4..2, " —3. TO Garl.6e
I 3,+,�_4.1 NOV 2 5 ?Qf19 'Z
HEAL ir1ucr- i . 2
v
fa_
0
Cs t?Ka GC
0
0
0
c1
Eac_L 110X I Fo0`r - AffiaoximA II TO SC.-2L e_ cv
Q
+ l N
rti
)A')N itI, CXiSirib6 Fiiilalli e vt
.y