HomeMy WebLinkAbout2015 Apr 09 - Sign Off Transmittal Sheet, Plan - New 2BR House of;qR4 TOWN OF YARMOUTH
�; � `��� HEALTH DEPARTMENT
� s
� ^�_••`� � PERNIIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed byApplicant:
Building Site Location: �y �.QiMeC�� ��1.� ��7� y�R'�bJ�G°
Proposed Improvement: 4v �t✓ z �e�n.op,� 2 �A Oy �a�^'c
Applicant: e.-�(>e"f" `K� �� � Tel.No.: ��- 3� y � Zz5�
Address: 20 �D/� �1i0 h^� �', �DUt�A �/��+n'h`'�"'t'`a Date Filed: �' !��fr""
*'lfyou would like e-mai[notrfication ofsign off,please provide e-marl address:
OwnerName: �U�<n�o � �l�
Owner Address: 2 � ���ts ��t r''�� ����''�"�� �4 Owner Tel.No.: 77Y'Z�f- /j�L
+
�
RESIDENTIAL AND/OR COMMERCIAL BUILDING
HEALTH DEPARTMENT: Determines Compiiance to Stste and Town Regulations; i.e., Requirements
For Septage Disposal and other Public Health Activities.
Flease submit three (3) copies of plans, to include:
(1.) Site Plan showing e�risting 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, roofing;
(3.) If necessary, Title 5 application signed by licensed installer
with fee. -
----........._...............__......_......._.........._............. ........._........__.....:............................_..................................:,.................................................................................._........................_.........�_.............._..........._........._.......
REVIEWED BY: C V CA�l�C.� DATE: '¢ / %�
PLEASE NOTE
COMIvvIENTS/CONDTTION • � Z ����
.G/�Gle�ol�/ ¢ �e��d?A�i� .ri �i .�i S �l�l�' - ��G'd'�
/,r�i/lil r2.Jc�/� � _ o t,h.,� /
0
co 0 r II
m cn I• P j �' 1 I
0> Ll CD
x cn
0 -q
0 M
co Cl?
m
0
X
ii
3* -1/2'— 6* 3* -6'
211-8 0
< CO
0 -n C11 CA CA
G-- 6
CO
-A
>
M
0
74 m
; r11
r
o
CO
Ln
-n
8
CL
CID
0
F)7ry
I pi�
O
mF-
CD
5-7 3/4*
m
0
=3
n
x
-A
IT!
0
74 m
; r11
p �M—
261
to
j
A I
74 m
r
o
CO
Ln
8
CL
CID
j
A I
1/2"
x
CID
Cz
mum &
al
m
0
>C',
A
CD ;0
, . OZ
0 6 -4
0 q rm —
C/) X M
0 r, V � -
Z
0
rn
m
0
74 m
o
CO
Ln
0
C
CL
CID
0
I pi�
cn
mF-
CD
m
0
=3
CA
6
0
-n
Q,
C;
IL
x -n
-4
cm
jr--
T-10"
1/2"
x
CID
Cz
mum &
al
m
0
>C',
A
CD ;0
, . OZ
0 6 -4
0 q rm —
C/) X M
0 r, V � -
Z
0
rn
m
0
I � j•j� i t - �i••i� c
,_ I i I
C2
j �r�' I w I I
CDo I i 4— I, �' >
4�.
I i �I I �`� r
C, x
CD
:L
r
cn
2n:
=0:-n
to
+
--------------- — I— — ----------------
j -------------
qT
----- -------
- — — — — — — — — — —
6'•6• —13'
7L
>
0 0 K
U)
V.
0C5
z
C) cn
mcozC)
m m m 00
r
Woo,
m 00
z
cn CD �71 0
CD
U)
X w
0
U) z
70 -
CA)
p
J.
k t
A
A6,
W9
S, go,
Zr�
P,i
I F, 5
gr
C)
0
C
CL
CID
I � j•j� i t - �i••i� c
,_ I i I
C2
j �r�' I w I I
CDo I i 4— I, �' >
4�.
I i �I I �`� r
C, x
CD
:L
r
cn
2n:
=0:-n
to
+
--------------- — I— — ----------------
j -------------
qT
----- -------
- — — — — — — — — — —
6'•6• —13'
7L
>
0 0 K
U)
V.
0C5
z
C) cn
mcozC)
m m m 00
r
Woo,
m 00
z
cn CD �71 0
CD
U)
X w
0
U) z
70 -
CA)
p
J.
k t
A
A6,
W9
S, go,
Zr�
P,i
I F, 5
gr