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2017 Jan 24 - Sign Off Transmittal, Floor Plans - Finish Basement - Family Room, Storage, Bathroom
.,-�.�--r�..r . _. _ ,� _ r..�. _�...�� �a,.. �.� �_.__ ,�� _ ��_ _ ,.�� __ .�.�„ �, X o�'Yq� �� TOWN OF YARMOUTH .�-�� �{� ' ;�- ° ..�"*' HEALTH DEPARTMENT o:._.� _ _ ,� ��~'`� `'��� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET ,.,,�,�Ne�, . To be completed by Applicant: Buildin Site Location: 2 � S U �// �/a 'v �p' g Proposed Improvement: '`vr �� �CP s �-r � % , r Gf � `. s"( APplicant: G�i / �i c,��, r�� �. Tel. N f S� �m � Z-- � � ��� � �4 �� (��Y�? � Address: / Z l -��-r ��t ��- �� Date Filed: t� /�'`lZ **Ifyou woudd like e-mail notafication ofsign off,please provide e-mail address: �✓� /'9 �� ��/v y��/ � �f< � �d/?7 Owner Name: �� � �/¢✓�� / �� , Owner Address: / � / 5 �/��v�, /�� Owner Tel.No.: 2 � � �i 3 Z ....................................................................�.........�Q'.r►._�_q�.............................................. ............................................................................................................................................................. 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 snowing existing buildings, water line location, �V 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; (3.) If necessary, Title 5 application signed by licensed installer with fee. REVIEWED BY: DATE: � � � PLEASE NOTE COMMENTS/CONDITIONS: , , , . , � � � � � � , , , � i � � i � � � 1 � � � � � � � _ � i � � � __ , � i _�.___ _ �__.____ _}._ __._ . ----...__ -r----.^...__._+----.___ _--r---, --__, ____._._. 4- --.._.. ._____...r_____.___ . . �________ � �--..._____ .__._ i_-- r t ! �' � t � � _� � . _ . , ( j ; .��- � ; � ; i � � i . i � . . i . � . (. . ` � � � � � � I � , � ; i , ; � � �. �� � � � � f � --------;----______ ;._ - --- +---- -___ � _-�__ -_--____ � ____. .� -- ---_--�____------�-- ---_-2� �_�0� _ ____ �'-- � -}-___--- t---- , �,-- } C� � ' � �; � � � ; � � � ; � ; � � � � �� o i � r i ! ; ` � r--- ? 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