HomeMy WebLinkAbout2010 Mar 16 - Sign Off Transmittal, Proposed Floor Plans - Enlarge Bedroom at .P...,
.
4.1g ,, e 4o . TOWN OF YARMOUTH
re,, a HEALTH DEPARTMENT
(nil ., 11`:, ,�.
MATTA 3 �.
'' 414"x'"° . PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: /3 /-a f/it,/ ./.0i./1 _ Map No.: Lot No.:
Proposed Improvement: G/v�,4ssr�� 2f GYsZo t ( y, 5/ ,, -- F-11 t-;o J"
4) 1 /—s. c e a„ - lam(.
Applicant: t S S f --./ 0,4 w (4,1c t c... Tel. No.: -Cc)Ste-`3 'a-ci //)--
Address: / 3 2,,,v/re/4,A cf ,%1 L/, "' ST ¢4 Gr mac/' Date Filed: .,/V/c
**Ifyou would like e-mail notification of sign off,please provide e-mail address: 1 -4 „5/ (it cC cd cc) e.,_ 66 J/,1 It 0 c
7_
Owner Name: /( (c sS O A-t t Ci'1 0-c..--
Owner Address: fe/e. L61 d (..4.- cc4 f L , Owner Tel. No.: G}Y-" 819'v // >----
‘---'
,.._ 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 linelocation,
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.
A 1111h
REVIEWED BY: / DATE: )1/6W/o
a
COMMENTS/CONDITIONS:
� /C/ PLEASE NOTE YC- 10 f c 04 q /1,-e•d vocM C