HomeMy WebLinkAbout2019 Apr 24 - Sign Off Transmittal, Floor Plan - Use & Occupancy Jt f TOWN OF YARMOUTH
HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: 1 0 7 ?auk e 2 2 w A R IN . A"A 02 tG(0 y
Proposed Improvement: u 5 t 4 cc-- P A C Pc fL , r:D 2 (�.k t AI L
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Applicant: D o^(3) e S L E b )0✓s Tel. No.: S3 'ri 2' (#& "
Address: I ° e"-k- e 2 2 '/A P. I'U i H 'M 1- O (Av `I Date Filed:
**lfyou would like e-mail notification of sign off please provide e-mail address: Ck61�cie ,1 5 's(iti C ti Co M(Gc 4e
Owner Name: A3 e( NOP-- S
Owner Address: ` U'S > t��-� �1 `3 OZ b 0 1 Owner Tel. No.: ?r\ C U
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.
REVIEWED BY: 9 ---.??6/01,--P---e.-/G�.r/� DATE: 'tel /9 f PLEASE NOTE
COMMENTS/CONDITIONS:
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DAVENPORT REALTY R(O a n T� A
20 North Main Street L
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SOUTH YARMOUTH,MA 02664
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YARMOUTHAll information deemed reliable but not guaranteed. 1 L"1RMOUTH
All properties are subject to prior sale or rental, SHOPPING PLAZA
change or withdrawal.Listing broker(s)and information
provider(s)shall not be responsible for any
typographical errors,misinformation,or misprints and
shall be held totally.harmless.