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HomeMy WebLinkAbout2015 May 11 - Sign Off Transmittal Sheet, Floor Plans _ __ __ ___ � _ � , � ". F .. . �-�_;'� `:'. 204�R,yo TOWN OF YARMOUTH � HEALTH DEPARTMENT �� • �.� o:-� � ��^�^���� PERMIT APPLICATIdN SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: � �� .L ���r�� Building Site Location: / o �� /iu.f� 02� � .Sc�L�-- ��Grry/ Uc.C�v ✓�1f, O� 6� � Proposed Improvement:�e�!/--� l C;'Vi vlT-,�C-e ST�r� � Applicant: �i h c1 C�v�D� � K ��t�C.� , Tel. No.: �a Lf� 2 �� q(O 3 Address: n b . �c�vt,5`��►'L� I�.�e t-c�c� `�crrr✓1a.,�-�-- �/taz6�j Date Filed:.$�'(�'�� •*Ifyou would/ike e-mail noJifrcation ofsign o,fj,'please pravide e-mail address: OwnerName: �rtcCOr�i� k ��cc�t'�- OwnerAddress: (�/� , C�ts}�»'lu �(.cx,��}"�4m�wrrlt�� OwnerTel.No.: �-�Gf� �G��-Q (o3 az G�- ,,; ............:....................................m. .. ..-............................... ........................................... ................. ..... ........ ... .... ... ............................................... . .... ... ... ..... ................................ ... RESIDENTIAL AND/OR CONIl�IERCIAL 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, roofang; (3.) If necessary, Title 5 application signed by licensed installer with fee. ? ....................................................................... .............. ...................................................................................................................................................................................................................................................................... REVIEWED BY: _ � "]/1"�/ DATE: �/�� /f s � —��- PLEASE NOTE COMMENTS/CONDITIONS: �� � l� � , ��'� �v�w SZrt7`c � /�t�t � /3-c �� C y� �r C � �I�Pt C �YP �G- N�jn - . - _ - / 1 J � � O � � \J" � � S � � � � � � ��� I . , � � � �� � + \ 1 � � I � � �J � �� � J � � a�LCfS :�� � e , � O � � � � � � �� � --��. a � � I � �"`�°Q� o � � � \� �i / � � �, � ____ ________ � b � ,� � i� ' � � � � � � �� � � � ��J � sk, Q � ,�� � 0 1� ,a � � ;,`°�C� � � M� ^�' � � �s ��� s � "� �' N � � � � K � � n � � � � � — � � � � r� -�.� _ � � o g � � � 1p � v � � � /