HomeMy WebLinkAbout2019 Feb 25 - Sign Off Transmittal, Floor Plan o1: YAR TOWN OF YARMOUTH
;�k !--`1c HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: 3 CAPT.IU JocLI(
Proposed Improvement: okIISIf Gt.OR00,10 11111414- IN 94SG/hlzuT
P4'1044" cT ( tcici `Dov2o(cl`'"' Joc-w'- Co Avtic;;1.' T OFr-l csZ
Applicant: . 6-PrI5 y lou46t Tel. No.: 7N -353 -fid-
Address: Di l Lk' Sr (kM 0J 1tf-fotir M/1- °eta r Date Filed: a -19
**If you would like e-mail notification of sign off,please provide e-mail address:U e Ff 6U cape home feral!',co"
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Owner Name: a414 Hlik6
Owner Address: 3 CV IM-'I' Porti( Owner Tel.No.:„5o 391
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 Isystem 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 bylicensed installer
with fee.
REVIEWED BY: I l DATE: cV), S r /
PLEASIL NOTE
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