HomeMy WebLinkAbout2019 Feb 13 - Sign Off Transmittal, Plans - 2 to 3 Bedrooms of "14k,, TOWN OF YARMOUTH
{ ..y j HEALTH DEPARTMENT
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St: PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: /00 /A/Di/4k/ , j ;jj 1L. 1iZ phai4a...,-/
Pr sed Improvement: 1-/IL/511 /I f i12Z'/ , / c`. %,r->< w
, - r 4„ r / u//�i�� C i < ,, . 1 G 734 Ti- /6'G0ih:
///f t'v; r/t c- " DD 1:-(*Z7S alm,o Ip Zr 94../9041/
Applicant: l /(106,0/,/}4-// lr`_/ / .4 C- Tel. No.:
Address: 14,vin f/R Date Filed: 02(J3 /1 7
**Ifyou would like e-mail notification ofsign off,please provide e-mail address:
Owner Name: 1/.1,44y 43f1lZ L C
Owner Address: /,lam' /4,:)./ J r//10o9`/a'2/' -L- ,///e.. Owner Tel. No.: '0,3?,rC2,2,, c
RESIDENTIAL AND/OR COMMERCIAL BUILDING
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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: DATE: (is/i
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PLEASE NOTE
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