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HomeMy WebLinkAbout2008 Jan 09 - Sign Off Transmittal Sheet - Use & Occupancy� __ __ -_-�.�-�� --�-�--� �..�._��,� -�-�-� � ,_�--�-----�--�---�-� � � ! ,�°��YA��o TOWN OF YARMOUTH o � ,��, HEALTH DEPARTMENT N MATTA M ESE � ��°"'"""°��c� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: �. 3 .�G�� � Building Site Location: �� �1/��������l�(j�/���7 �� Map No.: Lot No.: Proposed Improvement: ��{'�(J�°��G � "'— f C� SaQ-� ` � A licant: , Tel. No.:��C!'3'r1�"�4� `N/�� � pp � Address: f�UN�/�� �� ��� I'1���/V,� �lL��J� , �7t1 Date Filed: � ��' ( **I,f you would like e-mail notification of sign of�;'plerrse provide e-mail address: � Owner Name:� ��� Owner Address: Owner Tel. No.: _.....--__-.--...-----............................- -�------ - __..........__................................... ----- -...-.__............................... -- - -..................-----..................._.. -�... --.......----...__----.........------------------.... 1 RESIDEN�'IAL 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 four (4) copies of plans, to include: � (1.) Site Plan showing existing buildings, water liae location, and septic system location; (2.) Floor plan labeling ALL rooms within building � (all ezisting and proposed)— Note:Floor plans not required for decks, sheds, windows, roo�ng; i (3.) If necessary, Title 5 application signed by licensed installer � with fee. � . . .................��-� �� - ............... - - --.......................... � - - - ................... . ......................- - -� - -...............� � -- �-��-..........-�- -�- - - � J i —Tq �r,� i - REVIEWED BY: DATE: �l�� i PLEASE NOTE � COIVIlVIENTS/CONDITIONS: ' Y4�-'� V� � �H �G � G � P � � 7 � ��� -- � S� ! � � t ._.�__, __....__, - a r._____ -'-" ---_.-� �-- -------------- . I _____.._ ._____ ._.___.-- _ .__._.__ __ _ ____� . �- - - --a—.____.r � -�-�,�� �o�.c�, � �-C�,1��.�ttt'i , ;. ' ��.-�l�,. � ! -t�..��� � �3i�1 k.�2.,�� � � , r� I � � � � � ,. �; �' '`. _ � .� _f� � . � � < s_ __ . r a� ; �. ; . . . _ . _ � � � �. � ,. r �., _ . � _r � , � _ _� . _ ._. _ . ,..:; . _ , ;. � � � � ;, -- - ;�.�.;.,e �� _ �. ` � � t�. k� � t t 7 �^�3 4 {dv �'��� � �tSe ' C : d�s*`;r��*„,�a$�',.�»-• �` r"= - ._ �, �_ �, t'� '.t�2''�3-t�`�"r' ry�.� _ .. � 3 - . 'w J `f �. y.f,��� � "� i�, ��3�i £ � L � � ' �„`q � t� '�'a� � pi�.r��� y. w � �mPr'S c�„"`il .3. �s ��^'�,�,t ti i� �, 'H��� ���,T& d ,.i � � �s �' `� � : �` f i�r �§3 �,. s,v� p.��.s .���c 1F�� �, �''� . v d � . * ' � f s ,�� ,f` ;,� ,': �x �"35�'ip�� r_{fi � �-� t. • "�„ .`bi� T`Y:Y .:Q' .� �. �t"fif s A,� �� 4' ��"� �'� .'S�'' s.` � -�+a•�.,'�'��„`f�'� '4 �. � xa :� . ' .� a . ., .2 . '� xf �n J �. :".�F' $ �'y.�� T� ..3° r L � �Z� :'} '� a:-; �S-�-��� r -� ��4'e�E`�'� r'� r r' �� '�.� ;:�C',�. '�t�*s� r'� � "�3 �` r .��_t.= , �` , � t � ..: � `"� �� ' ���`' .���`�� % � ,.,.µ �� � � .*�o-"� � r�.rlC �� -, _ 'V � �. - L� �. � � . f � � �bl� � � � - � .` � -� � � � � � � :� � : , �; � . .; � � _ ._ � , _ � .� ? � � � _: .�t� N m s�n,.A a� ���