HomeMy WebLinkAbout2019 Apr 17 - Sign Off Transmittal, Floor Plans - Repair Water Damage oto , a , TOWN OF YARMOUTH
HEALTH DEPARTMENT
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PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: a s ()`i aC-
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Proposed Improvement: LA C. A. i‘J S 4-11-.4 77 cs e
40008' 'P ..)0rti.iN rZ.O ‘..- rt,zi 6.4v 1V4!.>
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Applicant: GO t k L� %AA, W'4 vat l k:w Tel. No.: S`u - '7 4.0 t 7
Address: Yvy,= t Crv\ tai y `<r�rvYS Date Filed: , 71 G �s
**/fyou would like e-mail notification of sign off please provide e-mail address:
Owner Name: C A 0-a l lv G 7"c.&N E S
?ao Coveel Or• Owner Tel. No.:
k,- lns .7 S"7 303 ?593
Owner Address:
v `�-1a ,►,� 3cV-L84 VA c;3
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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:
PLEASE NOTE
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