HomeMy WebLinkAbout2018 Aug 02 - Sign Off Transmittal Sheet, Plans - Dance Studio o Yah TOWN OF YARMOUTH
3 ° HEALTH DEPARTMENT
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• 4`0..0,7 • PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: /0 / �/c 5 7 ee1/4"he 28 5 fo re Z j
Proposed Improvement: --�,,,�-(� CZ) -�-c ,r car �.�4 -k� c.Q4S nrt
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Applicant: Lim eiSa ot>P1/oi(S Tel.No.: 56S-77 -3//G
Address: 21 ? vrn-I-0, "Di v¢ 1-47 J Date Filed: f-Z'
**Ifyou would like e-mail notification of sign off please provide e-mail address:
Owner Name: iVIckei ( .{Irck D.enn i 3 r
Owner Address:2Y 9 met i SI-• (.)./avc h w.rri cs 2S?( Owner Tel.No.: 5v15"'2?S--75-
RESIDENTIAL
'?SRESIDENTIAL 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.
1//REVIEWED BY: DATE: 1 -2 4P
PLEASE NOTE
COMMENTS/CONDITIONS:
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Yarmouth Health Department
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