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HomeMy WebLinkAbout2016 Mar 14 - Sign Off Transmittal Sheet, Floor Plan - Use & Occupancy r. � _ . � }o��q�,,� TOWN OF YARMOUTH � �.`�;�� HEALTH DEPARTMENT o:�,. � � ��`'''--�=-E`'� � PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: Building Site Location: � / o� I/ I Q,�/!1 ��• C�/� �j (�.�.�r f� �(/) �� rn�. Proposed Improvement: �tc�,YYL YY"1 G�e- �D-t�E e — �.�LQ f �C(��(:�-`1� C�l i Applicant: / IY� 5�-- ` Tel.No.: 7�y' ap(�'D�1�OS �} �/ p __. I � �� � Address: � l�C��/C. U�E?l,c� U�l��. �� ��Cc./''h�G(� �j� �' (,�6��IIat���i3�d: 3 ��� � y f **Ifyou would like e-mail notification ofsign off,please provide e-mail address: �(,�j�r�S���Pe [.� Q%y���Cry1 � Owner Name: C�C�)l� tr.���-- `��� � � A Owner Address:� �C)I�� VJ�EC� .�f• _ S� l�l(�i l�C���wner Tel.No.: ��y'�7r�� '���os ; �t..�- ca � � .........................................................................................................................................................�!�:�..�.�::::::--�...�::.........:::::.-..:......_�.. .................................................... � � �- r� � RESIDENTIAL AND/OR�,OMMERCIAL BUILDING �, HEALTH DEPARTMENT: Determines Compliance�St�te and Town Regulations; i.e., Requireme�fs� ,;�.`„� For Septage Disposal and other P�blic Health Activities. ' _� ��.._.___-� Please submit three (3) copies of pfans;to 'nclude: (1.) Site Plan showing existing buildings, ter l' e.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: DATE:� � �� � �` PLEASE NOTE COMMENTS/CONDITIONS: � ,�, r�� � � �- , � � � � y ( �n � f �� � � � y � ; � ..� , � � � .�j � � � � � J ` � �� � � •� � '.A a ; ` � v � � � o �„ / � tz _' `�i� ln 1� � � � .�f, �� ��? - � � -:� � � � � . �-� � � � � ' /y�i �,, s ��� �� 5���� � �