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Home My WebLink About2017 Apr 28 - Sign Off Transmittal, Floor Plan - Three Season Room __ _ ,..�,��-�-�-...,.� ,. ,�.... ._ .: .._.___ � . ._ , � ..% . . f --;�.., . ..., ti�Ya TOWN OF YARMOUTH .o �,�,.:�� , ��. ;° HEALTH DEPARTMENT o:..� "_ -+-� . ��"'��`��r� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: Building Site Location: i,I �U� d�t/( /�'jOt/Tiy ' Proposed Improvement: �,j,� C�i�.�c-r /�s � � (�/,7 � Applicant: rc�r' �/' ��h- t� Tel. No.: "�`��(o� �{ Address: // �A �n��'G �� /�--1 h•d�2--- Date Filed:��U�� ' **Ifyou would like e-mail notafication ofsign off,please provide e-mail address: �/�.�� 77 IY�� 4�( Owner Name: l/ri�T �/ iC.k. Ll /�, G ��7� Owner Address: /� ��rr` f4Y ��--�j-�--- Owner Tel. No.: �',?-0„r� .....................................................................................................::.......................................................................................................................................................................................................................................................... ; --, , RESIDENTIAL AND/OR COMMERCIAL BUILDING HEALTH DEPARTMENT: �etermines Compliance to State and Town Regulations; i.e., Requirements For Septage Disposal and other Public Health Activities. Please submit�bree (�) copies of plans, to include: (1.) Site Plan showing existing buildings, water line location, and �eptic 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: �7/^�''� I �' PLEASE NOTE COMMENTS/CONDITIONS: � �b _ � '-'� �2��e � �'�_ -�— ---- --- _ _ � --- - � .. 3 � � .�.r�! - -- i � � , ► � � � - � 6 � � ! _. - --i � - � - / --------�-- � .'---- ---- --..---------'- ' -_ � � � � -- �� ^' m � � _ _ � , c -- - Qm ---- -- - - -------- .� - ---� ------- _- � _ ---�,�---- ------- � ____ � - --� -_ - - ------ - - - —.o a