HomeMy WebLinkAbout2019 May 16 - Sign Off Transmittal, Floor Plan, Photos dt: TOWN OF YARMOUTH
HEALTH DEPARTMENT
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PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: 3 % ( 14,Y4 yQ0,oaV/ Q G'G
Proposed Improvement: .i I / ." e iIA 2 y,✓ .
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Applicant:PP d �� ������ /�� Tel. No.: �O�` 1/d7,74
Address: p Date Filed: S7/11 /i
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**If you would like e-mail notification of sign off please provide e-mail address: Co?“.ra.,„j 'e S Z cca C9"; (;"et,
Owner Name: , P R h -e tei e- P-Wa f'f D)1
Owner Address: / 7 y)4cY' ttJc 7 a9- Owner Tel. No.: SQ )01
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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: l C//
PLEASE NOTE
COMMENTS/CONDITIONS: c( lam- rt tD 7 ( /_
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23T WHITES PATH 5-16-2019
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23T WHITES PATH
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CAPE COD COOKIES TO GO PAGE 3 OF 4
23T WHITES PATH 5-16-2019
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