HomeMy WebLinkAbout2018 Dec 20 - Sign Off Transmittal, Floor Plans bt=YAk
TOWN OF YARMOUTH
`,� HEALTH DEPARTMENT
Y�sl,,.,„. , PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
n: h/,4d, Nig LA ' RmOV'�hBuilding Site Locatio
Proposed Improvement: f (1 V 1. I.. C . ' L t X t -- ' /Al I t (t'i k 1� Vfl t
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Applicant: /l i C 641`Ci a f/ g 5 i Tel. No.: ` r"" _4 1 t' l ?
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Address: 1S rI� U £. 1 M rlv' . ,r, q f1 J/ o c! th Date Filed: 1 ?If qi /7 .. f 7
**If you would like e-mail notification of sign off please provide e-mail address:
Owner Name: 8R I &-1l ` PPO [a. 1 1 S" F8 t'E 4 ( 4 V.'E' ,
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Owner Address: �� � , fne) u� Owner Tel. No.:
am`
,, (e i 42 171
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.
rr AdvREVIEWED BY: �(CIDATE: 2-.---o ''re
DATE: /
2,'
NOTE
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