HomeMy WebLinkAbout2015 May 07 - Sign Off Transmittal Sheet - Handicap Ramp , —_ , _ _ � __ _ __ . _ _ _ �
, , ,
t:
a,
, ,
� o4�AR4 � TOWN OF YARMOUTH �
�_ � `�>� _ HEALTH DEPARTMENT �\����
°� � � ..
��•`` � PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
�,.
� �/ '� C r N I�n S� �j�R/rt.c,�sn ��� nr
Building Site Location:,
Proposed Improvement: y��'/�-A /' ��4� (r'
�
I
Applicant: SPAi ivh �F /�u/►'� F' /ik Pn�D Tel.No.: �3 -i 7'� � �
�•�`� S��-<` d�`
Address: 1 �1 q 1�.°I 17r S�il �3�.r� �t o I a �,•�1�-"" S Date Filed: s -� �s
"Ijyou would like e-mail notification of sign off,please prmrde e-marl address:
Owner Name: f�l�'N/1 L A f/V u(1 ,;�� 1
�
Owner Address: �y 7 c �rL��� r3- '/i9 ff M.,,, %V/ P��T Owner Tel.No.� °� 3� �9�'�-
. RESIDENTIAL'AND/OR COMMERCIAL BUILDING ' �
�
HEALTH DEPARTMENT: Deternunes 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:Floor plans not required for decks,sheds,windows, roofang; �
(3.) �If necessary, Title 5 application signed by licensed installer
�uvith fee.
. ...._............................................
REVIEWED BY: DATE: � 7
PLEASE NOTE
COMMENTS/CONDITIONS:
�I
, �