HomeMy WebLinkAbout2015 Nov 20 - Sign Off Transmittal Sheet, Floor Plans - Convert Garage to Art Studio _---�--_- _ _____ . :-.��_ ___ _ _ _ a
{oF�qe,y TOWN OF YARMOUTH
o�)-`' HEALTH DEPARTMENT
� '^•<•�%�� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Locarion: 3Z CJ22e��a+�� ���<<,� �4�rt�oc�.�c, �0 f �
Proposed Improvement:_CDv�J2C� c��cc�tcL, -to a C � Si1�� p _ f e M�1.�
00� -� �lw.Ip�V �NWCu G. � r
Applicant: ��e'�t< (Ybt.,('�pv�- Tel.No.:
Address: �� Ci��h V 1�(�-J �r s• ��.�+1\S b2(6 O DateFiled: �-G /
*'IJ'you would like e-mail notification of sign off,please prwrde e-mail address:
Owner Name: �2�'-C� LC � GG�
OwnerAddress: �j ��l�l s�': �a�Mok"�..'P'�T OwnerTel. No.:S�f�SO`i '�Ig3�
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RESIDENTIAL AND/OR COMMERCIAL BUII,DING
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,
��d septic system location; _
�-^ (2.� Floor plan labeling ALL rooms within building '�
�' � �all ezisti�g and proposed) —
1Vote:Flbor 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: � /��� �I S
PLEASE NOTE
COMMENTS/CONDITIONS:
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