HomeMy WebLinkAbout2019 Apr 26 - Sign Off Transmittal, Plan - Covered Front Entry se:YA iv TOWN OF YARMOUTH Ei620W'ED
'' c HEALTH DEPARTMENT
APR 2 6 2019
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PERMIT APPLICATION SIGN OFF TRANSMITTAL SHI*LTH DEPT.
To be completed by Applicant:
Building Site Location: /9j . 6. 7/-/ -SEA S/:,
Proposed Improvement: 6-1.&// , L'
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Applicant: ej-//q/It:..) Lam- e-.Z../S Tel. No.: 764—7 --7
Address: 07 3e v?-#/ -SI 7 / Date Filed: & •
**lfyou would like e-mail notification ofsign off please provide e-mail address:
Owner Name:
Owner Address: 4Owner Tel.No.:
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: /if ,-
h � DATE: 4 J
PLEASE NOTE
COMMENTS/CONDITIONS:
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