HomeMy WebLinkAbout2019 Feb 11 - Sign Off Transmittal, Floor Plan Sketch t0-0"A, k* TOWN OF YARMOUTH
, - ° HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: 4 s / 4 A / 'f'l if. � 's /
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Proposed Improvement: /O 5 e //7 69 i'/J 1'1? ' /424r:-.112
Applicant: j7212i,1rda_ Tel. No.: ..2A5 /?' 7aO 7
Address: 4) lin 61111`, a S f y"t7- jh":67244/IDate Filed: //dip?
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**If you would like e-mail notification of sign off please provide e-mail address: ,�c5 ',1 'c'( /ç11/2'/1/11/2l
Owner Name: ,5'dfn1e 2 S aZiou�-
Owner Address: Owner Tel. No.:
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:
(I.) 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: FCi / i DATE: I E / i °I . 1
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PLEASE NOTE
COMMENTS/CONDITIONS:
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