HomeMy WebLinkAbout2017 May 09 - Sign Off Transmittal, Plans - Finish 3rd FloorTo be completed by Applicant:
Building Site Location:
Improvement:
TOWN OF YARMOUTH
HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
s
Applicant: 4 ----/V Vo 13e- i / � ,off S //y C Tel. No.: -15-0 E N_�6
-�
Address: d al y�/� Q � � Date Fi�G� T
Cyl 1 l
**Ifyou would like e-mail notification ofsign off, please provide e-mail address:
„_._
Owner Name: �� / ',1 r.. , �, / /0 -
Owner
G -
Owner Address:4 q �py?� 1 CCS h ALh ujod 17A, Owner Tel. No.: %d/�
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 :
PLEASE NOTE
SC cA, ( l 1 A e
DATE: �-- 1 s I
C vo