2019 Jan 11 - Sign Off Transmittal, Floor Plan - New 3BR House 3 0Y-.Y44„ TOWN OF YARMOUTH
HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: 62.,VG Z -� 2 ,.�JJ
Proposed Improvement: , 'o,,r^.4O Tgfc ir772d.- ' Ce'›. 2o(-)
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Applicant: G4 Tel No.:es-2--c:226-c9(Fe9•0
Address: 6(93 i ;77C ' J I?0#2 CI c O, i1112 Oc9G6d Date Filed:
"If you would like e-mail notification of sign off,please provide e-mail address: .2. .0 eC- j5I i.cf'p 6?-17,47e.
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Owner Name: 3 > �' ?7cx, '>7..?)` r L<Zae ,1ry , , 0
Owner Address: 7$?c rim.eC,Yv �, ' ("iv Owner Tel.No.:.)-U? ,mss-
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 meowing existing buildings, water line location,
and septic system location;
( . . l 1 e t , ro
(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.
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REVIEWED BY: t G� // �� DATE: /''"// , 7
PLEASE NOTE
COM NTS/CONDITIONS:
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BATH #2
<� jul
W.I.C.
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n _
RE FSR O
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7 1/2" 4'-0" 2'-0
F
RYAN W. BORING
U CIVIL
NO. 49506
�0 O
GISTEF�
s �
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plan 09, 2019
J .y
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z BEDROOM #1 _ a
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1609 LIGHT PEOD
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Northeast Region
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