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HomeMy WebLinkAbout2016 Jun 10 - Sign Off Transmittal Sheet - Use & Occupancy_ � m- -� --�-�-.��:� __ ��,�. �. , _ _.,, ,.�„�,.�_�..,P,�P-r _ _ ,�.�.�.4 ,. .. 04 Y�� TOWN OF YARMOUTH � "'�'k�a �, -,� HEALTH DEPARTMENT 0:..� .�� _ :j$ �t���r' ��.., �E- PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: Building Site Location: �Q � �D(�� � ?(�` ��� �� � �c �i �� � � Proposed Improvement: US� D� �� C C C��'C� 1i/C�9 r '��S I �1 i)R� /v'�' �p Sc-�c�� � 0 � Applicant: U 2 Tel. No.:,�j t�d-��' ���� i � Address: � '� o U � � 0��;� Date Filed:� 2Cl b **Ifyou woudd like e-mail notification ofsign off,please provide e-mail address: � , Owner Name: �/�! ;(l(r � � Owner Address: '=� �"�.�-. 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 existing and proposed) — ( Note:Floor plans not required for decks,sheds, windows, roofing; i (3.) If necessary, Title 5 application signed by licensed installer -.�---�, ; with fee. � i ..................................................................................... .. .........................:::................:..............: ...................................................................................... i ........ ..........................................................:................................................. REVIEWED BY: DATE: �' �� /� � I I PLEASE NOTE ( COMMENTS/CONDITIONS: � ,� I � , . - ��- �- �- �.. r �.,�µ r" � � ,�.) ✓ � � � � � � c'�� N'f�2 � � � � � � � � � � � � � � � r 4 � � � � � �� �- �' �' � . � � � �� � � � � � N - � o � � .� o � � �� � � � o � � c� � 0 � � � � � . _ o � c� � � � ,�. �^ `'� � � � � � u! �, �---�� � � `a _ a � .� . . � �Ll o w � � 0 � o �� � � � z Q C� � z �n Q Q ^ , � ,,� t � � � � �� `V � ` � \� � � �