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Home My WebLink About2017 Feb 27 - Sign Off Transmittal Sheet, Floor Plan - Use and Occupancy . . �. . .�.,,�- .,�.�, _ ��. ,_.- o'� '�a� TOWN OF YARMOUTH � `'"""*�" �r � `-'c HEALTH DEPARTMENT o:_�. � -� ��'''�=�-`��f� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: r� �� Building Site Location:_j�� 'y(�t�► .�-� _ �_^��, �� J'yl� � .{,�-,,,,� • Proposed Improvement: L �'. � � s'rc.� , � Applicant:' ,z � Tel.No.: .,��.2�,? ��S-� T � �--- �,,�"� f � I Address: -�� „n,i� i�ite.: /�. _ {� (•�,,n,t� /y?F} C�z,.S".� Date Filed: � / i r **If you would like e-mail notification of sign o,fJ;please provide e-mail address: OwnerName:f �r�a."S �R/7� 2-�diS Owner Address: �. �.�,n �j .�_ �llrr►�e��C � Owner Tel.No.: �-2�'—,3�,Z -�$9�.. mA�- ��3' ...................................................................................................................................................................................................................:.........................:.......................................................................................:.....:..........::.......:.. � 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) — Notes Floor plans not required for decks,sheds, windows, roofing; (3.) If necessary, Title 5 application signed by licensed installer with fee. ....................................................................................................................................... ...........................................................................................................................................................:............................................................ , � �� REVIEWED BY: • DATE: PLEASE NOTE �.. COMMENTS/CO�ITIONS: r a. L `1 ]�/1,v;T �1�S �. ( Cl�., c� �, � ; � � � ' _.�,_�..�,..� - �..�....._..,.�..�....�._.._.�.._.�. ��„ p ( � ' �- ' � � � � � i i � � � � ! � � i � � � � � �`' 'd � � � �} � � � I ,-- � � � � � w o (�' �_ � � � N Q I � �. �,� � `� v N � ; � r�� °� �' s �. � W � , ,� � � �� `�. � ,� � = I _ . � � � � � � � _ � � � ► � �� ,� � `�- �i k �`l � � i i ! � �� - — __...,........_..m_...._. - — -- --- .,.,�,.,_....:...,�...,..._.�.,...,.�..,....�w ' � ( �� , � � � � �. � . � � '�,.. � � � A� i � ; � _�.��...�.__��..��.�______ � � -- i �..,...e�� ; � � � � � ` ! ,� � ! � �` `� � �� a � � � � � `��K- i wa v ..�,____,_^___`.....-.,. - i � � \ � � 4 � �,I � h C �l (� t � � . ��. '�` � ' � � ! , ...._- . ___v_..._.._.___._.___�__.________._._._�..._..._.._.._. _.�._�...� � � � � i � � � � � E � � � � � � , � � � � f