HomeMy WebLinkAbout2019 May 01 - Sign Off Transmittal, Floor Plan - Use & Occupancy - Dance Studio o f TOWN OF YARMOUTH
5 f. 'a..t• HEALTH DEPARTMENT
• PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant: p
Building Site Location ,< , �� ,w ,. ��i #� k,l (, i� ,i,-`1 6 4 t 1
Proposed Improvement: 1;'i (I 6 c � �' C� TI) t
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Applicant: �. �'� � c Tel. No.: ' i� -(72,(0
Address: . is 1,�� 'f il`1 ti ''' `'� u
�-6 Date Filed:
**Ifyou would like e-mail notification ofsign off,please provide e-mail address: 161 if ( 1 ` ( ,C(0 HV( (,;G
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Owner Name: L.;-C(t .�D �.� -- F, ,, �� r
Owner Address: 2 � 1l` `�- (� 1-1
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i Owner Tel. No.: .x � S14 4114 2-1-1
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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.
REVIEWED BY:
DATE:
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PLEASE NOTE
COMMENTS/CONDITIONS:
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RECEIVED
MAY 012019
HEALTH DEPT.
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