HomeMy WebLinkAbout2015 Mar 30 - Sign Off Transmittal Sheet, Plans - Splitting up Commercial Space to 2 Units pF�R, R� TOWN OF YARMOUTH
o� "_'O�c� HEALTH DEPARTMENT
� �^�_°`�� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant.•
Building Site Locarion: S�� VC / �g
Pmposed Improvement: W���� � � ���/��� ����fi�(Q��� c�'Qv�� T
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Applicant: i//I• Tel. No.: �dF-7�/9�'Z7
Address: ,i Date Filed: �j'—�=/S
•s/fyou would like e-mail notifrcation of sign o�J;please pravide e-mail address:
OwnerName: ���F /'M�I4CYL/Ct. �G � �Ov✓ ZPG��)
Owner Address: /� �� {'1'T'�Ss �. Owner Tel. No.:�/1' "7 ����
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RESIDENTIAL AND/OR COMMERCIAL BUILDING
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements
For Septage Disposal and other Public Health Acfivities.
Please submit three (3) copies of plans, to include:
(1.) Site Plan showing existing buildings,water line location,
and septic system location; i
(2.) Floor plan labeling ALL rooms within building i
(all ezisting and proposed)-
Note:Floor plans not required for decks,sheds, windows, roofing;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
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REVIEWED BY: DATE: J� I`
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PLEAS�NOTE �
COMMENT /CONDITIONS:
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