HomeMy WebLinkAboutBuilding Department Sign offTOWN OF YARMOUTH
o� Yak
HEALTH DEPARTMENT
``�r PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location:
Proposed Improvement: o u 5 c i1 c/ E
C ��r�.(<-� ,c; �n c . �.v 1) A 1 I � L' � `0 ",c -,V3 i�( G N ct.V u F �s� i c • ] y
Applicant: �� ` _,� v� �t� 1 IV Tel. No.:
Address: i v c; A a Vv'_ (.,—As � .-� o c f L IC �1 e� � Date Filed: i i c? /zc-t
7
**Ifyou would like e-mail notification ofsign off, please provide e-mail address:
Owner Name: \(� 0 �, 1 � _, v
Owner Address: CA Z 1z O C't + F (0 A Owner Tel. No.: ,! C � 3 j
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:
COMMENTS/CONDITIONS :
....................................................................................................................................................................
DATE: I �� % 71
PLEASE NOTE
00
lu
C:2
i