HomeMy WebLinkAbout2019 Apr 03 - Sign Off Transmittal, Floor Plans - Basement Renovation {,0t..�,''YAk4 TOWN OF YARMOUTH
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tHEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: 6,9 6-7(c) C, 5 C / _ L . YJ� 'z.ciTW
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Proposed Improvement: 2,41>2 ./JJ +K'C v4`C4 uJ S .0ij
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Applicant: l' /60 Cis 5 '1 4.-Di 'A-Ay rC[-'v ao-c 4'6, Tel. No.:0 )1 366 9,23 7
Address: ii S (--reC L(/../- L / 0/2,404-111, Date Filed: OV QI` /9
**If you would like e-mail notification of sign off please provide e-mail address:
Owner Name: / iC-W('( ,40 iri
Owner Address: /1/44,4t
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,�� "T �6t �" l� '�• /vi.4 4)01./.44- Owner Tel. No.:77Y 37( 3 7
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 lading 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: P6DATE: %/ —3 __.- ( ci'
PLEASE NOTE
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