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Home My WebLink About2017 Jun 01 - Sign Off Transmittal Sheet, Floor Plans o��Ya� TOWN OF YARMOUTH .• .�.�,:� �, - ��_y HEALTH DEPARTMENT o:..� . �'�'',��``�� pERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: Building Site Location: -,:�� r�Q � l 'E' �-�(/U —r--- .,--_ �—j � Proposed Improvement: � �/ .S W1 C �'u1,�...,.. ✓e V�v.er�' �C, w � t✓` /1�.`r" /� /� � ' Applicant: /f '�Pir/�4 (� ��S'LC�� Tel. No.: J` 0�'?/�`�/.1��.. Address: � il.Q,�2 ir..�. .ac..Y//�/�'2 " Date Filed: i � � � � - **If you would dike e-mail notification of sign off,pdease�rovide e-mail address: � �1.,� ��4, X Owner Name: �u��''r�L'� � (�U�3Pl�� ,�r� �� Owner Address: � �� (��(/-�' Owner Tel.No.:��—�/7',3/�� .............................................................................................................................................................. ....................................................................................:.....................................................................�:................................. .-�� ENTIAL ANA70R COMMERCIAL BUILDING�� HEALTH DEPARTMENT: Determines Compl��e to State and Town Regulations; i.e., Requirernents For Septage Dispos�and other Public Health Activities. Please submit t�ee (3) copies of plans, to include: (1.) Site Plan �owiag existing buildings, water line location, ;� and septic�ystem location; (2.) Floor pla�abeling ALL rooms within building (all existing and proposed) — _ Note:Flobr��3lans not required for decks,sheds, windows, roofng; (3.) If necessal�;Title 5 application signed by licensed installer with fee. ...............................................................................................:..:......................:...:....:...........................................................................................................:...............................:............................. .......................................................... REVIEWED BY: DATE: � � �� PLEASE NOTE COMMENTS/CONDITIO : ( GcS'-e w�'� G� � �-e v�� c' G S � �� /'a C/�.1 , � i r ��0 � rS L Gv�.. I 1 � _._._ .�.�.�.�,_�_. _._____� _...�...� -_ } � � � { � � , �``'' � . � � � � � � �� '� f�� k ^.,,, � �� . ,� ,.,� ; � � � � � ; � � ��:� � � � � �� ' � ` � � _:_ . � ; __- --- � - � � ,____ � , � �----------� � � � � �.��._�._�_ � � � ,� � . � �;. `� �a v� �' � �. ! � � = � � �, _ .______ __�_�. � � , : � � ��p j -� � �- � t � C . ; a � a # � (wJ c� w � 9 N � - . � o t-=- � -t� � Z � � ,� [� � _ � � � .. � � � � � -� � � ; � i � � � � � � � � � � � �► i � � � ; i , , a4o A PROVIDE REQUIRED MAKE4JPAIR F �) E -F ,$4, ? 4 4J(2 v� JUN 0 12017 HEALTH DEPT