HomeMy WebLinkAbout2018 Oct 10 - Sign Off Transmittal, Plans - New 3BR House 1 � TOWN OF YARMOUTH
r o. ,�q : HEALTH DEPARTMENT
''' t!i% PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: 55 r) -if-1-wood od L- re
Proposed Improvement: new , be rt room home
Applicant: Ch- v-i j 1t Rte.iSne..te- S ;41- 9 . Tel. No.: 5o&-3(Q-7- 5 SS3
Address: P.D. 3611 tSH ,90,r r11C,v"k-v, RA-1- � )111G4. t,o 1Date Filed: a
**If you would like e-mail notification of sign off,please provide e-mail address: /0 r/d-/C /1/4 ,,y j c
Owner Name: Slit 1"A.e
Owner Address: Owner 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 °'614,01/*/ DATE: /d /6 71
PLEASE NOTE
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