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Home My WebLink About2011 Feb 08 - Sign Off Transmittal Sheet, Floor Plan _ .r �: �.._ ..___.. __ .- �,.>,�-.-- - :-- — � _ 4 : � �G� �p°GSc..s" ��'�, a4;a;,?�.� TOWN OF YARMOUTH s'��G HEALTH DEPARTMENT o. �-� � � '�'-�-�%l� PEI2MIT APPLICATION SIGN OFF TRANSMITTAL SHEET � To be compteted by Applicant: Building Site Locarion: /�7 ,� �G�rTl o�� Od7`j� ��ir+o�TLi ;'%/�' �7��br��/- Pmpased Improvement� � ��C� cS �s v� � r:r v r��, a� w � ��1 r� ( �_�r .��- c� r � r� ��''L� � €� �s , : Applicartt: G� LL<S � � � r ✓'r` vI �^I t"' L. Tel. No.: �7C� L f�7/��- Address: /(77l' ��vTF �� -S"O+/T<1 ��'ffrhro✓l'`� ///�y?��pateFiled: �',%� -�"r3� lZ. � '*Ify'ou would tike e-maif notiftcation of sign ofJ;ptease provide e-mail address: �- u� —��r.�� h c��Z 3y� ��l�la�7p,c�a„t Owner P1ame: � �- ,� � i c' :� 1 /''l � --� �OWner Address: .2 �-{s� � !�1,q �c� S� ��i 19c�y,� �/,e E 2 > >'� Uwner Tel.No.: �.��t� � G!�7 /!i ) � i � ._..._......__..._.�........_..........._........___............_..........._....._..._.........__..........._.__....__...........____.�....___......._....__._.............._.__..._...._.............._...._..._.........._........._.............._.__.._..._...__.._..........._..__....... J RESIDENTIAL ANDJOR GOMMERCIAL BUILDING HEALTH DEPARTMENT: Determines Compliance to State and Town Regulatians; i.e., Requirernents For Septage Disposal and othar Public Heatth Activities. Please submit three (3) copies of plans, to include: ' (1.) Site Plan showing existing buildings, water line location, � and septic system loeation; E � (2.} Floor plan�labeling ALL raoms within building I {a!1 existing and propased) — Note:Floor plans aot required for decks,sheds, windows, roofing; ' (3.) If necessary, Title 5 apptication signed by licensed instaDer � with fee. ; i _.__.......___......._..................._............_.__.... ......___... ...._._.. ... ...........__...__.._........_....._........_...._......._.__._..........._...__.._...__....._...__......._..............._.............._......__......_....._..........._._.._......__ �� , i REVIEWEI7 BY:_ - � ��DATE: � -c.,r PLEASE NOTE � CQMMEI+iTS1CONDITIt7NS: / U U � in rc' �~ �h 3 t�r � c �� • , c✓t/ 2 c. e I�ri l^ C / J?� �"�-�M/1 �.�C..�-� — C ��c. �'�nq �` rY� '�. � �,S N' iAY ��ru��/�� . �..-__...-_.._.T._.�_.__-..___.� .__._..._ .-...�..._._. �..._-.._- � r � ��w�� q � " ----------_'— �{ec#r� h�a'tieTt . �p`Kt�. �G�ys��`� ' Q',�4,�.pq'AG� . 1� � V Q . �� t� ��t �� _ � � � �,}ht�=^ �� L��i$ FL,ovu �� y W I��J , �� +�Op w�. � � � ' ' t{�'(� �iN++1 . � � �� A�� '`�F � 0 � � V � � -� � j� � � � � 2 � '�:.1 �' � � 'J �' � � � � � �. � � � . � � � � � C� . � � C� � � � � � � � � � � a �- � � a � ,EKT�',NC� ��11' � � � � �I ��'��Sw�� "o�b�`f t`�� _�-- {2o v.�.�- �--`�