HomeMy WebLinkAbout2019 Jun 04 - Sign Off Transmittal, Floor Plan - Use & Occupancy TOWN OF YARMOUTH
HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: 1 I 093 Of / f'(I Qt f', /IA 4 .), G'23
Proposed Improvement: t 'M. v{I 't kir-,c r GW c I , -t4 c t
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Applicant: K€1 r-rev, : Tel No.. `3 " •/` _ /113
Address: ') "41 Rx f° le D t Filed: 41(9 /el
**!f you would like e-mail notification of sign off please provide e-mail address: ' 1i t're 36 t {e.cirv.
Owner Name: r Gt°►►k rdj 1'✓'
Owner Address: � � G Owner Tel. No.: C
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.
PIease 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: t1 2. !- DATE: � `7 '/7;�
PLEASE NOTE
COMMENTS/CO DI ONS:
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