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HomeMy WebLinkAbout2009 Dec 10 - Sign Off Transmittal Sheet, Floor Plan - Use and Occupancy � ����. �� , �_ T, _ ,_ �. ` a Y °F� `�'Q�o TOWN OF YARMOUTH � � � o y HEALTH DEPARTMENT ; � H wwTrw n "� - i � ��'� � PERM1'I`APPLICATION SIGN OFF TRANSMiTTAL SHEET , ;<'��ir� � To be completed by Applicant: � � , � Building Site Location: Map No.: Lot No.: i Proposed Improvement: I ,p /� t ApPlicant: /�'/TA �N/�RD %Nt�% p�PS %�UR�� TeL No.: 5D 8 - 79� - /95 7 � 02L73 ' Address: .5 9'y /�Aiiv >i. �/ 2 8 'r✓F�i fq,Pr�euTM f�l A Date Filed: � *slfyou would[ike e-mail notificalion ofsign oJf,please provide e-mail address: OwnerName: �f�7<'�/�.Piiv /�COs.Pi�K�s�r� j � OwnerAddress:231 'r✓plNv S'� —��G'�S /nFi a�9oc p��Te1. No.: � i f10/h£ - 7B / - 23t 2�fi2 (��t2 9'>£ Gg� 5�' �S , _.............._......._........._..............._..........._.__...__.........._............................_.__..__._...._._..........._..........._......______.... ___....._..._..._.__.........._......__................._....._..._._..............._......................_......._...._.._._. I RESIDENTIAL AND/OR COMMERCIAL BUILDING i i HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements � For Septage Disposal and other Public Health Activities. ; Please submit four(4) copies of plans, to include: j (1.) Site Plan showing existing buildings, water line locafion, i and septic system location; i (2.) Floor plan labeling ALL rooms within building ' (all existing and proposed) — � Note: Floor plans not required for decks, sheds, windows, roofing; I (3.) If necessary, Tit}e 5 application signed by Gcensed installer � � with fee. _...._..___ - _...__._.._._.__ ._.._..__ ._........._........_......_...................................................................._.._._.........._....__..... j REVIEWED BY: �� C/CE/G�wu�-! DATE: I 2 - /�'`�J � I I PLEASE NOTE _ ! coNnv�r�rrsicormrrio�s: ��,v� rl�ra�I�S s �ii /�r��//r�li/ ��v�/���� / _� S�G�T�� �G/ �rl /JGC�Y Z`d i o�zdl�/ilQi i-�t� � i � 1—___�_._.______. ._,.. .. ...._ _ . . BACX D007Q . ._._. \ .._. _._......... .. .._.�__..___'___.__ D��rsr��NG ' 1 7rs��-� � ,� I � I L.... , ------1 E�r`'�-I yY/�L i� � ,N . (�1ACh1r/L' -- ------ __ � ; Rr,=,�;c�reA�,e+ � ! � j I C6 p°�� � , : � ; �_ .. __ __ � ; K�T�� E�N n��� � __� � � � ; � [- � � ', �+ + � j�nny y:NA�rDy�� � � � � � Reort � � i � �:N l � � y i I _.,__._..__ ... � .... ... .. .. .. � , _; ...._. . . . .i I �VN-r�yL � I L[IUNT�fi I � , , _ � r. _.. _ ' � t � � i � ; ' � --I p ; ❑ 1'7 _ +� .' --� 7Aes%-f� I L, 6"-a� S 'iAR1-£� `���f '-- . � —� ! ' L--- i � � '� ,� I , �' �' i : ; � ; q , r�- - � I q I� }-rr�err. ---� ---� i-- , Tit[scc; t»n�£ � � , ' Tl+St� ; p' __—� r� __.__...__._.."'�n I 4_.__.._ _f � � c : j � � , ��n�� ti C7 �ilA�5 it� r------- --! � � i I �fv`T � I C� U _ . � . / 1 � `YRY�;-L' ;. . . � ... .. . .. .� . � ; �'.� . �... ----...... . F1CC^r'! pCCR