HomeMy WebLinkAbout2017 Jul 26 - Sign Off Transmittal, Floor Plans - New 3BR Single Family House t'Ya TOWN OF YARMOUTH
G HEALTH DEPARTMENT
'`_.. ° PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: t- S r� e G✓p farm cart
Proposed Improvement: /t/�w Co 51-/- U C i i 6 3 b P/roc,�-� 5,,� , 7LQ mi ��Grsr
Applicant: /1c-1.14- ) 61a r v 9 y Tel. No.: 77 V a 96 /)0
Address: V P /v,e‘a rte" 0,00) Date Filed: (, - /0 -/7
**Ifyou would like e-mail notification of sign off please provide e-mail address: 647 r/ a at o 7 Co rri
Owner Name; GQ(-✓7 -7-2-6-i7 412-•-/te-1/
Owner Address: rs _PT /1'?, „ Owner Tel. No.: '77/-)9 -11°
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.
Alc)C,e0404/ -'REVIEWED BY: DATE: �.Z� /7
PLEASE NOTE
CO MENTS/CONDITIONS:
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