HomeMy WebLinkAbout2010 Apr 16 - Sign Off Transmittal, Floor Plan - Use & Occupancyr
TOWN OF YARMOUTH
HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant. -
Building Site Location: {5 m � c nV ; c Me a r rn o A) Map No.: Lot No.:
Proposed Improvement: /s C) We( -GA '\oh5 ` U5F ' O v Gyc� *Disk Y_11 �icr, of Shocks
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Applicant: PCAf .QV �nac Y5 LL C , Tel. No.: 5CA -- 5 q3 -I91i
NA Date Filed: S 20 U
Address: 2 And e C. 1�f10..c� Sv►�E One Ox crt�. AC' ( i
**Ifyou would like_e-mail notification ofsign off, please provide e-mail address-, 130Sor, S C"L� Tn - Z 1 G _ 0 zj --
Owner Name:
Owner Address: 2.0 k C1,yNV1 C, N� E \ a,T Mo �;, Owner Tel. No.: SO ' ` %" 3 2 q i
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 four (4) copies of plans, to include:
(L) 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:
PLEASE NOTE
COMMENTS/CONDITIONS: / f
DATE:
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