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HomeMy WebLinkAbout2014 Oct 30 - Sign Off Transmittal Sheet - Use & Occupancy r..,,.. . . . _ _ _._ .__ . y _ _.,,� . T.-.-.r , '_'._ . �- .. . .. . . . ..... ... . ' . � " � { � �� oF�aR TOWN OF YARMOUTH / .�- ,� � 3� `��� HEALTH DEPARTMENT 30 � ; < �' � '"•<�°`� x �.+�ERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: Building Site Location: /v�3 �JfI Ji✓�Sr�o ' Iei�- GY� ��i9�i T' s' ��/y�tOlj2� Proposed Improvement: ��-C� /'✓'"� �O A/U ePoJ� GI - Trn �"�2t 0 ���S JC,��� �vs� �` �v0r� ��73 i�� j /� / \ � � Applicant: eC 1��3 L�}�Gn.G^� �� / �f177�/�2 �,WSiGP� l�/= Tel.No.: .��T/$a'zC/�/CJ�� . � Ac.�1t /v�3b Address: ��'(�11J)/>�lj lSGY✓�i ��71�'�i �}�'�/9Y� /Y��6�1i�d- Date Filed: /O-d�/ / •'Ifyou would like e-mail not�cation ofsigrr o,[J,'please pravide e-mai[address: 16J/�//1`�P2/G�S ��iY/� ��- L�87J/1 Owner Name: �/��P7�"�- 7�ZUD L�`� Owner Address: � O. B 0 DC a() ( � /�.ep')/,��i�G2�"/Y1 J�}'Owner Tel. No.:�7i I' a�-93 l/ _...._....__..._......._:.::......_.......__..._........:......_..._........._........._...................._............................................_................._lJ�✓o�5�......................................................................................_........ ,� RESIDENTIAL AND/OR CO�RCIAL BUILDING HE�I,TH DEPARTMENT: Determines Compliance to State and,Town Regulations; i.e.,Requirements , , - For Septage,Aisposal and other Public Health Activities. Please submit three (3) copies of plans, to include: (1.� Site Plan showing e�ist�ng buildings,vrater 1' " tion, and septic system locafion; , • (2.) Floor plAp I�lieling ALL rooms witl�in buil ' , ; ' (a11 existing and proposed)— " Note:Floor plans not requiredfor,,decks,sheds, windows,roofing; � ' (3.) 3f necessary, Title 5 application signed by licensed installer with fee. � REVIEWED BY: � DATE; �� 3 � �7 PLEASE NOTE a� COMR�NTS/CONDTI'IONS: , � 1 i � . � ri � l; ✓ -