HomeMy WebLinkAbout2019 May 15 - Sign Off Transmittal - Going back from 1 to 2 Bedrooms t'1'R
�fko TOWN OF YARMOUTH
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HEALTH DEPARTMENT
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1/4.\`: ~ '.,4 PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: 2 I -/7. -e..C V ,s 1 s,,_ 2-13,J = it".s ` xzt rt,u,,'
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Proposed Improvement: i''_., ,- > > :-�, '7,.)�, . :u ' ' '' ...r 0t kA, 1"-`row ....� o'� v6 --r,
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Applicant:�� .. s ��,1�Z,>�� -1'41_�=.- Tel. No..: L�,� -=��� -
Address:.,... 1 ►f_L. v i S I u'..! )- C ,,J I I-4J,Tr S >/i3J m v Ti z Date Filed: z...51//,,9'
**lf you would like e-mail notification of sign off please provide e-mail address:
Owner Name: !:\.,,._, 3-7r' r.N,r',,
Owner Address:--:e'I it-'2 Y is i ti,v Pr' t, ' ..`i'" ,e A,C4N, Owner Tel.No::-<- w ' /
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: r, IN
(1.) Site Plan showing existing buildings, water line location,
and septic system location;
(2.) Floor plan labeling ALL rooms within building
I. (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: c 7
PLEASE NOTE
COMMENTS/CONDITION : ,
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