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Home My WebLink About2016 Feb 05 - Sign Off Transmittal Sheet, Floor Plan ---- _.T, _.._.�.-�.�_,.��n,� _�,,__..,_,�.a-�,�a— _ .�__�.__._.__�.z._�..-�r-.-.,.-- . . � �� ,�.-„,� o�..'�R�e TOWN OF YARMOUTH �'� �a.w��, HEALTH DEPARTMENT �` � e � . � � ''�-��`*� � PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be compdeted by Applicant: Building Site Location: �jQ-� �[) "T Yti� �5 t`f �,� �1, Y l� f'4 O v T� Pro osed Improvement: I C�GL L I I�1 S �r t Y D� �N ST�tM � �� - � t� , � � (� �#' ✓ � t �W C� !�c, . ��j/�d �'w.� f'?C1 S'iJ'/�'!J-Cr l F��}1�191� l Applicant:�`�,1�,�,f��.�Sa S7 t�c�t�-�� Tel.No.: ` � -�� Address: I z�-T E-�-U�V L �N 1'�-`�( ��' `1`ti-��V�t ,� V T I� Date Filed: S **Ifyou would like e-mail notification ofsign off,please provide e-maid address: / rn Owner Name: '��/ �1� ��/L 1 ii .,� � ,�,�.,.�:. { Owner Address: Owner Tel.No.: ZZ �'3�� a � ..................................................................................................::.:...........................................................................................:............................................................................................................................................................... ; ..�.._� RESIDTNTIAL A,ND/OR COMIVIERCIAL BUILDING �: HEALTH DEPARTMENT: Deterrnines 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 egisting 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: s DATE: a� S� �� PLEASE NOTE COMMENTS/CONDITIONS: .�"' �CX�St �+c w�c+��*� -- � (�,�,,��'J — o� V�jJ --- �. 13�S�e-�S�` t,cJct- � -.�.......� y � , � n� � � � � i i i Q � a , �l d w � N � n�p � vp�� p J � . . L�-Jv� *�.s . . . . . . � Q . . '� 11 = � � � . �� .� � � � � � � � �; '� � � , � �� f':� � -.�-� '� �� P�' � � v � 4��` �'� t.`� �� ,�;� ,.� vq ,� �., � �:�. t� � �. �� I � -�- � � � ._ ,�- , �,�, � �.- i �. � � � � � ,' p� � C��, - � 'fi , ., � ,� t � ; � � _� r � � . . . A � �' '�_. � "� ,,� � � � � � � � � °� � ��' � _" �� v � � ``�� ` � � � "�J �'. � �` �. �.r.� � � � �1 � £ � � �� `cio , � _ ��'a �� , � � �° , � � _ .� � �� y� � - -� � . c� `r� � i-� �, ; � -� ..r� i � � � `" _ � �, � � ' � .. � �� _ � ! � �'` . ; .._ . u� , � � � . � - ��:- � , �� . . . .�. � . . ..... �' � . .. .. .. . . . . .. . . ... � . . ,� �� s�_�. .� _ _ �� . t� ; . � , - . �� - - � ' -------- ------ — — -- ; . __ ------- _ — - ' _ . _ �. _ r _ � . �