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HomeMy WebLinkAbout2010 Jun 29 - Sign Off Transmittal - Use & OccupancyoY _Yap TOWN OF YARMOUTH HEALTH DEPARTMENT PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: Building Site Location: t 0 el Applicant:OMMA AIIY►PC'�UC.• NEA YEAKI ITT B&tC '�C�C)�'..1 Tel.No.:r {� Address: j J U?C-'_ WMrc- Sal 0 *MoUIP M4 OVzI14 Date Filed: **Ifyou would like e-mail notification of sign off, please provide e-mail address: Owner Name:b(g)(1 MIj I N W W-1 W161P, Owner Address: 1111 MAIM SfTZLT% St1fi- 966 hAI1 j} ,STY 15201 Owner Tel. No.: 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 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 not required for decks, sheds, windows, roofing; (3.) If necessary, Title 5 application signed by licensed installer with fee. REVIEWED BY: DATE: 4� ? /© PILEASE NOTE COMMENTS/CONDITIONS: _ // / c) K F' r to c G'- A A 6 �G � z° C """ OA i O � c K t' 7` C I USe J