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Home My WebLink About2007 Feb 21 - Sign Off Transmittal Sheet, Sketch, Pictures - Patio . , .... ,:� , : _ . ,. :, �--�-,,._.,.--�-�-.--�.--� — _ — _ -�-�-,--� � .,- . F .. i i f �' o,�° ��y TOWN OF YARMOUTH HEALTH DEPARTMENT N�„��+�,�� PERMIT APpLICATION SIGN OFF TRANSMiTTAL SHEET To be completed by Applicant: Building Site I.ocation:� ��e �/e r„ /„�.,,� Map No.: Lot No.: .� Proposed Improvement:�,.,,�_,G i��/ ��.o �"v ' x /d � r' APPlicam:�'-��a`.�.�r��-*-�/.�/�, �a- s Tel. No.: SaSr-2fra- S�tr3 Address:_ � -/��a�c �/a�., G,..,..e_ Date Fil�b`�� " � '7 i *#Ijyou wovld fike e-mail notification ofsign ojj,'please pravide e-mai!address: Owner Name: �r � ,.P 6 �e 7r� i � Owner Address: i�7 SL.�oP�� v Owner Tel. No.: C7�K afu-S'/S y RESIDENTIAL ANDlOR COMII�RCIAL BUILDING HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements For Septage Disposal and other Public Health Activities. Please submit four(4) copies of plans, to include: (1.) Site Plan showing existing buildings, water line location, and septic §ystem location; (2.) Floor plan labeling ALL rooms within building (all existing and proposed) - Note:Floor plans not required for decks, sheds, windaws, roofing; (3.) If necessary, Title 5 application signed by licensed installer with fee. ---...................__........_.........-............../ _............__.._......................_._.................- -.._........_-........................ ____._._......._ __.......... REVIEWED BY: DATE: d/et�/�� PLEASE NOTE COMII�NTS/CONDTl'IONS: t oT a�8.1. l mAP GZS 1 � .�,. - LOT NO. :��_�ADDRESS :_� �dl�l�"�i�'Gp��'�'y UIJNERS NAA(E : �- 07✓` T— SEIdAGE PERMIT NO. : q��37NEW: REFAIR: DATE ISSUEll :,$�(o- l��DfiTE IPISTALLED : //--9-97 Li]STALLERS NAME : �/`T�G�/L'(��6� INSTALLATIO�I OF : s� PG..�� /---�� WATER TABLE : FINAL INSPECTI01� gy ; (p6S?�D� DftAWING OF I1vSTALLATZON ON REVERSE SID�� A � - <Z, � i--16 ', A � ^ �Z � Z �y2 >r ,4- 3 - �;_;_ �3 „ `1`6 ,� y �� ` � g�L� 6 �, e " B 3 Z N . _ _ _ __ _ _ _ _ __ _ _ _ _ _ __ . ... . _. _ . .... � . . . ._. . . . . . 3 _ . . . . . . . . .. J . . ._ ___ . . . . .. . . . . . . . �._ .__. . ... � ... . .. .. . . ; . . . . . ..... .. . . . .. . ._ _ . __. � i . . . . . . , . . . _.. . . . . ._ . . . . .. . _ t � ' ... _. . ... . . _. . . . . .. . ` _ . . . _ . . . . . . . . F . . .. ._ . .. . . __. . . . . . I . . . ._. . .. . . ,� � .... . . . . . _ . . . . . .) . . �1 _. . .. . . . . i . ... . _. . . . � . , ... . . . . � `. . .... F . . . . . ... . . . .. .. _. !. .... . _.. . 1 ,.. ...1 .. .. . . i ... . � . _.. . . . .._ . _ . . _ � . .. . . . �_._ . � � . _.. . __ . . . _ . . . . . . . . . . .., .._ _. _ .. . � � . ._.. � . __ _ _ . ��,. ., . . . .. . . � . . . .. . . . . � . . . . _.. i-? � � L � C� ._. _ . . _. . . . . . . _. . . .. . _ . � .. . . . . _. . . �.._ � � . _. ��.. F X 'r .`a_.t ?. ,v `. . .. � . .. . _ . . ._ . . _ _ 7'j i-�T L i7 I N(Y _ .. .. 'L . . . . G. . . � . _ _ . . . . . .. . ._. Q . . _._. + f, __ .. _ . . . .. ._�_,._.�.:._.._..._._..,._,. . i . . . _.. � � .._ . . . . . . __. . . . _ . . .. _ . .. . �_ j � x � .� r �nJCr _�es ✓\ _ � .. . ..I U � . . . P� - �_ ,�l � }1� . �_ . . .. _ ' J�� ''p r , : _ . . . .. . . , I (�� r'J O j'-'�i i'� f Q f� .. _. . . ,". , 1 j . . . .. ._ f ! . _ . . . . . . ._. ... . � 0 � . . . _ . _. ._ . .... .. . . .... . . ... . . _ . . . . . . . . . . . . . . _... . . _ .. .. . .. . . . . . . . . . . . ... . . _ . . _.. �JU-�� r__. a� � � .. . . . . . ._ . . ... . . .. ... � - � � ' � � :_ , � � _= , ; _ __ __ _ , —�- — _, _ _ , . _ _ ---� � — :� _ a . � , x`. � _ � � � ��Illlll I��° `��: ��, ; ,. ��i; i � �� e:::..3 ,F.:a.:.... .��iii�� !i� �� _I � ,.� , � ..,.. .........� .;._.•.� - .. .... . . vri. � _ ,.:� , —.�� , � � � k -w`" j` ��:.E ' �.a s-.>,a�"�'+`�.4�4'`'�y, "' _ y-�ry� ..5�-.� � .. ._ R � �S _ . �. � ^S: i. . � • ]t3�"Tj''. V�- ,`..a�,�6 rt��:.v,� .� •"' _ i p_ ..a _+"�� . . . ,yy. - . ' .. . , �. €� �w. ""}��q' �rt � . _7f^�' , . ' T ^- �2 .+t'- � < � - : ` '`t '� eys+t�• �-`z.Y� , ^ .q n."�'3 � �vt4 rr 'y�-��'�-i�..�'B+t�ti,..� i�-.CR.:� _ . , « .. ..4d�i-:�.`�' � - ., r.,. . ^'�."�� . : �� , _v , ;rt �� . :. _ _ . �� Q _ � �� `'' � l . � �� — � — � � e �, �� , �� _ k �"III I I �i ... + �.a� T. ��1�� fllff .. � ' ,��_ .. � __ ' �I ��)I��.' � .jyr € nunnnuul IIIIIillll�� ,_�, ��'-�r ,•....-v....�.... � w c, •��'�� . �'`:S�'�''.�Ni•;*i`�'..... �• ♦aO�JJ� - � � �r � �..__��-..`�..