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HomeMy WebLinkAbout2010 Jan 29 - Sign Off Transmittal Sheet - Use & Occupancy '�"}P.'^c^^".�-..�,,.-,T-..r--�.�op.n�..� --"Ra-..�..-r- ...:.�m..�. .. .,:..--.,"'r." -+..x+sg a.n .-��' � ... . � - .o."_ . .. ' . "1","�'3_.�n2F..��r:.�--mr��.-��..`�..�w-�..�.�.�.f-.-.-�...r�_.a—.-.a..-..�.r�-"--•- _ " _- '� N. � � . . : .. . . . � . .. � . - � .. . .. . .. . . � �: . � � . � . . , ., . . . . . . . Y.'.� . . . . . � . . . . OF��'� , �,�� �[ TOWN OF YARMOUTH o _ , y HEALTH DEPARTMENT N�~"��T o+"SG,�� PERMTI'APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: . Building Site Location: 2.'3�#*Z t,Ja-�►�c�.S 'pia�.� Map No.: Lot No.: Proposed Improvement: N-- --� � � ¢�� � � $-Pcc Applicant: ��.=�ZrT -I�Sr�, > � gx7R,�y ��C.oN,S' Tel. No.: Sog- 39y- 1'ZoC� Address: �;S�2 �ti�� ��,,-rµ �,. �/���v-�-N � M�,. Date Filed: **If you would like e-mail notification of sign o,f,j;please provide e-mail address: Y � ` ' Owner Name: �,_,c.�c� i,ay ' LLC Owner Address: 23 6 2 �►-�.� -p,�� S y p,�.A„�,�r N�N��Owner Tel. No.:sag-39 4-�4 Z t} ..--�----.....--�----�..............................................................................................................................�---..........---.........--��--�-�-��----....._........-�----....... RESIDENTIAL AND/OR COMMERCIAL BUILDING � HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements . For Septage Disposa.l and other Public Health Activities. � � 1 Please submit four (4) copies of plans, to include: ' ! � (1.) Site Plan showing ezisting buildings, water line location, � and septic system location; , �, � i : (2.) Floor plan labeling ALL rooms within building � � (all ezisting and proposed)- i Note:Floor plans not required for decks, sheds, windows, rooftng; � (3.), If necessary, Title 5 application signed by licensed installer � ` with fee. � REVIEWED BY: DATE: � vl /�� ! PLEASE NOTE COMI��NTS/CONDITIONS: f !� �+�. i �h �„ ' ^I l,..��- �t;�..,�C — � f �a 1 �- r�VsT' ��►�,.� , � r-��e ��,,, � �, ���, � ♦ b I �� �• � ��. � �� St+�K. ! �,T� o '� c��r 0 �- S ��, .�- � Q � y oa� , C G� � --�r' 1���►A � � C�� [�C�C�f��M(�D I � ,1AN 2 9 2�10 � f� HEAL►H �►�r�'. S l d SO s,4 �-r, �aB��l 6-�c.�tit► S" 23 S � 2 t,Ju�-r�s T��-�� S. �►42�.c��, 1`11� c�Z�4