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Home My WebLink About2017 Feb 02 - Sign Off Transmittal Sheet, Floor Plan - Use & Occupancy .,.,_� _ _ ,�-T .,��. i T � .o��,� TOWN OF YARMOUTH R�CE,�/�D j �� `�;� HEALTH DEPARTMENT F�R 0 � 1q17 o;.�.. � rH ��''��-E%�f� PERMIT APPLICATION SIGN OFF TRANSMITTAL S EALTH DEPT. ' To be completed by Applicant: ` � � � ! �� Building�Site Location: �'� � � � ''% -�d u<��;�t,.� �� 'Y�� 1/� � ;, _ Proposed Improvement: L�^�-� �':;�� j,�� L7 C-c r�:=::�� '� /�� t..J p c�,�� ►Y" , ..Sp � ' : iR�.� - S ��,� l,.��-�,� /s nv �c/ �,�r,�'� Tr.�/ =-l�� APPlicant: ,� { t r� ( (� 'I'el.No.: � =l �-� �G �' j -?r..� v Address: S` a n �,, fi. � �-_� � :.. ��,� .t ,,��.�.:�t� �r�.� � � � /� �'�� Date Filed: �z _ n � - z� t 7, **If you woudd like e-mail notifrcation of sign off,please provide e-maid address: l.-z 5�c��a-.r c� �� ir�, I�,,, ,,x�, ��,_,.,.., Owner Name: 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 in�lude: (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 ndt required for decks,sheds, windows, roofing; � � (3.) If�necessary, Title 5 application signed by licensed installer �� with fee. ........................................................................... ....................................................................................................................................................................................................................................................................:............ REVIEWED BY: DATE: p2 � � ' PLEASE NOTE COMMENTS/COI�D�T�I_O�NS�� G�II._ � G (� r --- �l Q C� � r-- ., el-v ct �' v ti�� . �,.,, � __ � : , � _ ! . � ; ---- ��. �— t� '� � � �. ._ . ,�•.r-...._. �� ._._.. - , 3 } ��,� -- � ,� � m� � E �"�`__—=� .�..} � � I ' a Q i � � _=:�� s i t].�l� �� ;' -_� a,, � i � � � � � � �� X � i `� � .�,�! � �1�� =� , �'' q� � � � ��' y ,� C�� `}i_i . � � i',`'� � � i � - - �� d �... �---� �z�. - f V` .; ,� ,� r � '� �.�� :�� '� � �� .� I , . : � �� . � v _� � a`� � �� - � � � � ' � `' `.� �� I � � ,r� � r� ��.��, � � � � .�-: , � � � �.,.. x� � �q- '= a� � �-�.' r-i- ' � �" ; :,,�' � � � �� J ��,`� � i � � � � � � � � � � �� } ��v � i �. ."' '� �' Q `' ' � �# h � ' � � t.,_ � � , ; �.� � �, � �:; ,� p i ; � � i � �9 •�S�� '� 4��; i � � �- � � � :'� 1 � v ---�.; }:. . �-----__.... i � �:k+j `T`"�'� ..� ' � • .. ' " �� +� � �� w�� j � \ � � j �� J 'v� `1 .� j I � 11� M _s , :... � 'J`� 9� J � i•`' �. � � .,``_ � � �� M�� . ' . �'� 1' � I .___ < ! '�C�}."a. ' s ' ! ` �"� ?_"__--? ��'L� �J� £ �' . _.i � r� � . � ' � � � � °� n, � �} �:� � 1 �d . .;ir. �6 3 'i 'ti. j �_ _. -- � � r,� ,�,�. � , �•�-) � .�_.. � � � � a,� �,----� ��`_ �"`_-- ��;� � Q�� .� � i � ,. , o � �� x a � ' ��;a�::.,j �.�.,: G ,� �s� � _ ---._ ;. �;� �� ` _l,. � �� '�� 2, � � �.:, r � ; '� `� t�'� ,. � �� ,0 `� r ;v ':�: �— ; ,"'' �.'�,— .,,,_ : , -� , � � , _ y ,-.� \ � ! + ...�...,�,a.�\ . .�. � �� ' .. _. � 4 £ � :4 � � .�-'._-- — _ �� . 1 = { .� � ..�, ��. 4 .._.._. ! �e�d�3 7 �• ..J,� '--•, 'k b � S�. V� _i � � °•�, � ., ' ��, �. � �.�� t ' .� �.,• �.� � �Q � �` � ; ,� � � �ri ..�., � r } ;,:: � � --'`� .�" �� i�,. �; ,-- ti' � . `�� _ ; . ,� ' _ ____. _..e. ��. � `�; �.,� ;� ``��, � � � , �-:- �� `o �+ � ,-_. (_..� ,� � `t�. � -� � � .,�� ',i,�``�... � � � � � `� f� « V � �— . .