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2015 Aug 27 - Sign Off Transmittal Sheet, Floor Plans - Convert Garage to Family Room.,�-._�, �. ..,�d:..,��.,�.., �;,�.,.�..�:..T,�.��.�_,,..�,. .�_..,.,��.-,�..�.�v,._.. �,��,-_ . . . _____ __� � ,. _�,., �.� .r ��, . . . . .:�� .,.� ._ . ..�� o�.�q� TOWN OF YARMOUTH � � �� HEALTH DEPARTMENT �' � `�<.c 1-� °�,--� ,��.� r�,�� PERMIT APPLICATiON SIGN OFF TRANSMITTAL SHEET . To be completed by Applicant: Building Site Location: 1 ��'1 /{' / �►^� ��G C2- ti �t i� � �`�'` ./�5 Q� � � Proposed Improvement: �U�h c,<� i�► �v c r,,,� �a �� d -- 'v�s Pr►.P Applicant:�� \G C c��5 _Tel.No.: S�8 �g y b y�6 Address:�, b��?f �y y t�6!�u v`�, ( �r'� f� 6 75 Date Filed: **I.f'you woudd dike e-mail notification of sign off,please provide e-mail address: Owner Name:�c,v� �+ ��c.�kr c� � Z -_ i Owner Address: � / a r. � � � ��►'�-�Q��1,. Owner Tel.No.: .........................................................................................................................................................................................................................................:........................................................................................................................ RESIDENTIAL AND/OR COMMERCIAL BUILDING HEALTH DEPARTMENT: Determines 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) — i Note:Floor plans not required for decks,sheds, windows, roofing; ' (3.) If necessary, Title 5 application signed by licensed installer ' with fee. ...................................................................................................................................................................................................................................................................................................................................................................... I REVIEW�D BY: �C� DATE: �`' 2 7 %� PLEASE NOTE CO MEN S/CON ITIONS: • � ��r �t�' ��`"�� uc r` .t � � �16/ � , � .� , �''S. d v� ; , 1 � 3 17 S � ; I i � � ; �o� � '��r� �° a / � � �� l � . s�l�1�� ''/f a� �o,�� _ � ; � S c�.,'� "`! � � �� - � ' � �� a c� . � S � � ? o- �� II ; � �� . � .�- vz r�yr � � ��Q�l .� � � e A � A vu � p� ,��'`,�1�,� a,W a a � � � �SP�� .�� _ `� � _ - � ; � _ _ - xa __ � a _ � � 0 � Y f!Y ��.= « R �� , , ! a � 1 ; � 1 � � �! ��1'�� / � V � �� ; J � : �...� . "'-r � G � �� 4, ';� � � � � ` I �, � � � �� ' �dl _ �s'c* � �t A � �