HomeMy WebLinkAbout2015 Mar 24 - Sign Off Transmittal Sheet, Plans �2of�qR,�G TOWN OF YARMOUTH
° HEALTH DEPARTMENT
� '^•_••%Js PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicand:
Building Site Location: �S A.VAR/NA 2�� i (�, y/J�Q.A7l�UY�1/
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Proposed Improvement: Y�� Uc�x.t- a UG/` — 17�a
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Applicant: l�rn./v.� �G'�us�r�� Tel. No.: �/O/ /Bd�OS��
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Address: P, �/lus ����io Nh4- Date Filed: ,3-a y -/5�
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•"Ifyou would like e-mail notrfication of sign o�J.'please prwrde e-mail address:
Owner Name: �t�i�/� b� s�/�d�t �/� c%fw�
Owner Address: ��' �a,��,(/s(�c�, �(,���j�/Owner Te1. No.�JO.�-yy�l --r S'�/7�
........_..............._....................................._..................................................................................................................................................................................................................................................................._.................
RESIDENTIAL AND/OR COMNIERCIAL 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:F[oor plans not required for decks,sheds, windows, roofing;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
REVIEWED BY: DATE: � � � �S
LEASE NOTE
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