HomeMy WebLinkAbout2019 May 17 - Sign Off Transmittal, Floor Plans - Renovations13 0 � ^ TOWN OF YARMOUTH
ILA A .° HEALTH DEPARTMENT
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PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To e completed by Applicant:
(Building Site Location: 1;- AI'M�hpz)ILV) 17-h Aj �9' 7
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Proposed Improvement: 'f,U i r< < �� Kl7(/l 1j��I tr ill J ; ��� Gh3 �r�� U r� iv 1-'A;,y 7 -JV VI)
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Applicant: ;'/1 A./ /r7/,' �! S Tel. No.:
Address:'/ �t�x IZl�� /1..d� !7`�<-.��� 1r�/�'��� ��;i' ✓t�1,=t rI ? �s' �y�t Date Filed: S 9
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**lfyou would like e-mail notification ofsign off, please provide e-mail address: I #%V' C _1?/" "} A-6 ������ 61Y' �
Owner Name:_x,��#r
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Owner Address: zIA) /ui) A j/,, a 1('le ,19d�11,,i 1Y1,4 � Z
� Owner Tel. No.: I/
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:
COMMENTS/CONDITI
PLEASE NOTE
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RECEIVED
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HEALTH DEPT.
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RECEIVED
MAY 17 2019
HEALTH
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RECEIVE®
•SAY 112019
HEALTH DEPT.