HomeMy WebLinkAbout2018 Jul 30 - Sign Off Transmittal TOWN OF YARMOUTH
HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location:9p� CS S\• 0.t Ov \ Rik p2-4.0(9-
Proposed Improvement:6%G..\est y-C a.GSL- 7, t v 1'f\
1-joc 'L
Applicant:3W She_ S0.-C e S Tel.No.: 17 r7 a3 (0,S-32--
Address:
0s"32-Address: ).14 N1aS`.�e,e �2 c�- Zok 0- o2L 9 Date Filed: 1-3G 4g-t
**If you would like e-mail notification of sign off please provide e-mail address:
Owner Name: RR-4 Y\Oa \�:CAN.04-*ok �c,
Owner Address:iia t oc S. �ac c�okA, la-GL(1. Owner Tel.No.: 9T-1 4C i V 35 7 j
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: "c()Cb Oak DATE: -7-31 '7
PLEASE NOTE
COMMENTS/CONDITIONS:
h ccteta,G4 <-erlAr s' — ; / , Z, .aG , rn
/` 2 ',�- � t%P/7 6-10 �
7/1/49' (fr, 0,44,./ - raca',ey>4(1/143
p0,e01 o troif( ' FL S/ 7i2 /e--7 7