HomeMy WebLinkAbout2019 May 30 - Sign Off Transmittal, Sketch - Unheated Enclosed Porch ,
of :TOWN OF YARMOUTH
- HEALTH DEPARTMENT
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�{c...`' PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
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Building Site Location: 14 v o ka Was{ V a . j v c, A v
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Proposed Improvement: Cl o s a r 6,411.ha, 1
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Applicant: t2)01\,(Aft- &..f C 1 l t P 2., Tel. No.:v566*-1 76- 5C11-3 I
Address: t q e to yell- AA • Date Filed: 5130)&i 7
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**Ifyou would like e-mail notification ofsign off please provide e-mail address:
Owner Name: /1/I Cl o v :g /
S`F ay�G��
Owner Address: N e1 c, veY�'.. QA e /Av v%l cc.`-, Owner Tel. No.:. '- 774
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.
C ��REVIEWED BY: l - C ��. � PLEASE NOTE DATE: 9
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Yarmouth Health Department
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ame Date