HomeMy WebLinkAbout2019 Feb 25 - Sign Off Transmittal, Floor Plans TOWN OF YARMOUTH
HEALTH DEPARTMENT
`V`.. PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant: p 1,0 / /Building Site Location: 3 � `e_, �.Or A'ri' �SrV‘ 01469
Proposed Impro ement: \AC6Se, Pit ' IP a cjA l
- „a. - • ,# ' c'et=7;k5 it) tAn 11^01.4
Applicant: 1� `�G�C��-� ,D� Tel. No.: 7(% TiA, W-t73
Address: 3 C I:r"ct& (lu fkrfrL4 \ ! 'UOa r66 Date Filed: 7
**/fyou would like e-mail notification of sign off,please provide e-mail address:
Owner Name: 5a1'(,e
Owner Address: same-- Owner Tel. No.: 3'17 401i '2311J
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:
(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: + DATE: "Acfl
PLEASE NOTE •
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