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Home My WebLink About2010 Mar 04 - Sign Off Transmittal Sheet - Opening Motel . _:: .. , ,. . ;,_ . �� .._- , �a��Y �c TOWN QF YARM�UTH y HEALTH�P�kRT'1VfENT . ��'�°ab'�� PEItMTf AP'PLICAITON 31GN OFF fiRe1NSMITTAL 3HEET To be completed byApplicam: Building Site Location: 1 °o� 3 7 �� o�� ..��„� �p No.:� Lot No.:�5g i 9, � ( ProposedImprovement: �� , � I� �� 1 sZti r�.�rC c.-s. � 1�) \� M MN (� (�N� .� �/'� ( 4A. ��tCBDt: �C.� c P__ \f� �( ( P.� - \. r Tel. No.: �6�-3`�7 /�S `-1 � `� � '� � � �� M � Address: � �._-�e �n o.r o � �S�Date Filed: 3- ��— /G' •*Ilyau would like e-mail rooh;ficaAion ofsign off,p[ease provide e-mail address: M V �9 C'C e�� i@ 4' �a � I • C G� Owner Name: � G�n � e l �� r f c \� , � � ��a s �a \c, o ""� _ r Owner Address: � � �p e.� S� M �� c,,�i � � o�7S�jvr,ner Tel. No.: SG�- 3 5'7- l z S� . RESIDENTIAL ANDiOR COMMERCIAL BUII.DING HEALTH DEPARTMENT: Detennines Compliance to State and Town Regulations; i.e., R�uiremems For Septage Disposal and other Public Health Activities. Please sebmit four(4) copies �plans, to inelude: (1.) Site Plan showing existing;buildings,water line location, and septic system location;� . (2.) Floor plan labeling��►oms within buiiding (all eaisting and pro 1 ")- Note:F7oar'p/ans wot�wqutrea fot decks, skeds, windows, sarfrnSi ' (3.) If necessary, Title 5.application signed by licensed installer with fee. � _........_.._......._.._...._._..............---...__........__._....__.......__.-� --- - REVIEWED BY: DATE:�l��U' � PLEASE NOTE CO1vHvfENTS/CONDTl'I�1�FS: 1 /� ?�U rwl'r�, c�N� `� ( � 13 d V uG.v.�. �� Y�tl'�NK � (�GIIT`� k1 ��. t�t �IJIw... Rv^IN � \ �SI �'- O` )h' / rvw. _ ti a Ffct,v T ( — �, ;�� ..�a.,.-, �^�,a-�� v,..�„�, �, i,�„� I �«� p�,,, l c�iT � (z� �� o r�, � .