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HomeMy WebLinkAbout2015 Jan 21 - Sign Off Transmittal Sheet, Plans - New 4 BR HomeI . ...,.. _. . . . . . . . . . . . . ._ .. . . ... . « ..:..�. .:_._ ._ . . . _ . . . .. . '✓ 4 � • � _� 2oF�q!e,� TOWN OF YARMOUTH � - � �� HEALTH DEPARTMENT o � ` � '`���•�`�� � PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: BuildingSiteLocation: \l CI�ZZ�(,E LAa�r .�Ih�MDU'CN �a� ProposedImprovement: 1��c.� \'o�.� 5tl8 �8S BIoB"2. A licant: ��k��nzz��z �.vc.. t �i.lS�s. Tel.N .. --� PP �3�.� c,qd �7� Address: \p`� i�`c�c 4r S't. .�� 'sJ��S ��Q. o ��38 Date Fil���� �� ec�eaaE. '*Ifyou would like e-mail notification afsign o,�j;pleasepravide e-marl address: ����,�(1��Y @ S�C C�L�1e�pL.\Ej Owner Name: �F;�;2 �-�c��xthpc.y� � � _ _ � _ .-_-, ��,�'c� -Owner Address: � � �-�,r �.�-��� �;���� A' i��'Owner Te1. No.:C. � � c �=,� �,�C,� � �';�Z�tZc�a \_ ._......_....._........_..........................._.........................._......................................................................................................................................................................................................................................x_:::.:..._......_..... RESIDENTIAL AND/OR COD'IMEERCIAL BUILDING HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements For Septage Disposal and other Public Health Activities. s r P"lease-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[oot plans not required for decks,sheds, windows, roofing; (3.) If necessary, Title 5 application sign� by?IiGensed installer with fee. ' s : ,. -� . _... l > � .........�c� ._}::.��' � t .............. ......... ..... . ..............._ �t� .::"......... _..._.....__..... W...>.,�.. ... ............. ............ .......... R�VIEWED$Y: `t� DATE: �--Z/ l� \ ,,;. -�•; ; �, .ST�- / PLEASE NOTE COMMENTS/CONDITIO S: �/� �vsc�/ � ��`�YY7 /�,.�//`� �i����`-�9�4/ S ����. t��. ��� �,_ �— , y 1lz°�E !�L! �=�''T O ;ILI o i no _ •Q + r I t CLLO rT y _ J Mp 7, f PAI - 7= L, 41 s ry. 4 6D • 171, cs k 17 • �'= �' � gip- __ `�' . • ` .. Ll , . _; --. . . � i .. • ' ' O .'`�,�, '! � • cc's N r 19 lit j Cs i _ O 19 lit j Cs