HomeMy WebLinkAbout2019 Mar 11 - Sign Off Transmittal, Floor Plans TOWN OF YARMOUTH
s ; HEALTH DEPARTMENT
r �v ,�. RECEIVED
`/ PERMIT APPLICATION SIGN OFF TRANSMITTAL SHE
KR 2019
To be completed by Applicant: HEALTH DEPT.
Building Site Location: IAN \<-1
Proposed Improvement: -
Applicant: Tel. No.: Ncz 232
Address: �� � S��°�� �'�c�J� �� Date Filed:
**If you would like e-mail notification of sign off please provide e-mail address:
Owner Name: �—��S ��2� cw� �� ,:,,� CZC—
Owner Address:�� `S'"��U '��
� �— Owner Tel. No.: 2:32\- C'`
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 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: I / DATE: 34 //
PLEASE NOTE
COMMENTS/CONDITIONS: I i_ '
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