HomeMy WebLinkAbout2019 Apr 11 - Sign Off Transmittal, Floor Plan - Going from 3 BR to 2 BR TOWN OF YARMOUTH
HEALTH DEPARTMENT
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PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: _ _ • ^ - • e r= b-_ - 75
Proposed Improvement: ._� ,�_ _ •
_ .
Applicant: s�s�,. INA_ Tel. No.: c i 7-C4 C/2 070
Address: ) (Q wo Q -p p 1,,,t•
t•v11a.. ?Ott-M4 oz e0 7c- Date F i led:
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**/fyou would like e-mail notification of sign off,please provide e-mail address: 5 i'A U {Zc 1c(isuk:.I . C 6 we
Owner Name:$v» M.Q J k e..,gk: -o'1d.3 6 Act g M u(5 t
Owner Address: ' L. z nj , s-r r�o-t- t frviiinel 'Po ter Owner Tel. No.:
I IV4- oa075—
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.
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REVIEWED BY: - - DATE: 11-1 H
P EASE NOTE
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