HomeMy WebLinkAbout2019 Apr 02 - Sign Off Transmittal, Floor Plan ot-Y'tk TOWN OF YARMOUTH
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-="t`' PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: 9 DAP` MOO tsoA..( `1. P. Ma 02.4is
Proposed Improvement: C.<nn P-rt ?,00,.35 2o6M.. A&c ,t E.. L-,A' A(, & --
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Applicant: jek N�1Ert-t /.- • LUCAS Tel. No.: 413 .3-74-- ( 902...
Address: DAR c m-0o ct A`( Y.c). MA (37.4-tS Date Filed: 'T- )-- t 1
**If you would like e-mail notification of sign off please provide e-mail address: W1(4..)C..0.5 4-1 „,) yµ5h. con-%
Owner Name: 4C-omentN. 4 A--tLe J L. L -c 5
Owner Address: y7 AZTAA0 WA-I Y R MA a26i5 Owner Tel.No.: 413 314-1902,,,
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.) *loor 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: 06-\".....7ir'''
DATE; 1 .)` 1 cr
PLEASE NOTE
COMMENTS/CONDITIONS: �J
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LOT NO . : 3 Q ADDRESS : 41 - Dcdroulor 4
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OWNERS NAME :
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SEWAGE PERMIT NO. 17- 117 NEW: ‘/ REPA IR :
DATE . ISSUED::..L.-1.1- /DATE INSTALLED : 147
INSTALLERS NAME : '--6cyt opx.35 Ex c��ti V
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INSTALLATION OF : D•�3 - 14; - c4
Np ATER TABLE : lS 'FINAL INSPECTION BY : Flre/t4mr
DRAWING OF INSTALLATION ON REVERSE SIDE :
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