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Home My WebLink About2014 Jul 21 - Sign Off Transmittal Sheet, Floor Plans � � , �� . _ � ._.;_ _ , :_ _.� - �..�-.: �. _e�P. � oF;�,y, TOWN OF YARMOUTH �2 - �_� HEALTH DEPARTMENT o� -� �; , . x •�,_•°`' -"PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: 1 l��.r�4.... HU✓5-L � �F�' w.�t uw s T Building Site Location: (0 W/l/OU� h�'1 S. /4 P�t o u ��( �'lQ . �� / ProposedImprovexnent: j-�i� �JlGS ��/n-�vul �l�t�r� `t��vliv�W . 5/K� i.'aa/4'S�'"��'S —�� -- (' Applicant:�� - S�'okf �°(Qr7,✓i Tel.No.: �il��I�/�-S�Ig`� � Address: � �X/1��1@�(,� L.o��, �/�YY1 dfi��1 I'lq D��y Date Filed:�' b- �- � �'� '•Ijyou wovld like e-marl notification ofsign oJj,please prmrde e-mail address: Owner Name: �S�D� �!'1%v1 Owner Address: �Q �,(Ji f�OGJ L.h J, \�G��rtb u� no, Owner Tel. No.:.j�-9'/%�-�9' r �ESIDENTIAL 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: (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 pdans not requdred for decks,sheds, wlndows,roofing; (3.) If necessary, Title 5 application signed by licensed installer � �' with fee. _..._.._................_........................_................._.......... .............................................. .......................................................................................................................................................................__................._............................. REVIEWED BY: DATE: �^��~ � (- PLEASE NOTE COMIvfENT5/CONDITIONS: '� + "'�._..�.--t-.-- ��C+t n�S �, (�/rfin P-t� � C� ne .�._ �� s-' n� � 3 � � M1 � � � 1,� `_ t � s � � � ! y � � � w � � o � _ � � � �c � � � 1 �, � a � � � �� - �. � .� � ` ! � � �' � s-rt � � ' i � � ; •� . �w � j`` � . �i f ,Q, � ��,� � o � � ` t � , � " q ; 1� ;�� t� � � � ti = I j Q L�^ �, � \. 1 � "6J Il � � � G � � � � ��! � � � � i fl �� C� � �� y P} �,,.� V 'y� � � � � , C � s a -� 3 t c�'�. � � � �a�a � m Q '� � � � � .r - L ` � �. ti � s � �-�' � '�— � `s �i- , — � _ � -� � �� _ `'"` � `b � � � `�_; � � � 4' -� ` }c �1"' � " cn � �, � -� � � �. � 1 � , �: � � ( F � � � i �[1 !� r" h: � � p � � [� o w Sf i3" � � a�C � T � �k �-} �' � � � C� � N r � '�4 � � _1� � °�`' � S � °� l`1,S SA c � i � � . � � cr I �^~ 3'�,'�,P � �� 6 � � � � � � . , �-� � �_ � � �, �_ � - ,, � � t� �.. �- � 1 ' s � � �7� � k ��'�' Q' '� � �n � � � � J ._,,� �- --- ca, —L t _ 4t too -am I I t 00� , ,,.