HomeMy WebLinkAbout2019 May 15 - Sign Off Transmittal - Landing Jt-- k TOWN OF YARMOUTH
r, - r y HEALTH DEPARTMENT
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PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: '?tA v ei6(0 Qk.
Proposed Improvement: k { I. N t re
Applicant: )(1 fn. 1(t/Utl - �e1. No.: Sdb� 2- (11/
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Address: ?Y' L C ( Alt"'. fi-u 4 (�)a,A Date Filed: -
**Ifyou would like e-mail notification of sign off,please provide e-mail address
Owner Name: )sA DOG.)S� I
Owner Address: 1 2- , v c ?,t Pa,te, V - Owner Tel. No.: 7117
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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: SV,/ //'
PLEASE NOTE
COMMENTS/CONDITIONS: