HomeMy WebLinkAbout2019 Jul 17 - Sign Off Transmittal, Plans - 2nd Fl Bath o'`-. mak, TOWN OF YARMOUTH
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HEALTH DEPARTMENT
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PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: -1 t tA, s N.`T C v C Ci r c.. /E.
Proposed Improvement: (..\ c c.... v , k tr-- 1c v/ 091„
Applicant: t vA 1' , Vr z Tel. No.:4C3 ?S9 oft
Address: ( )c 't—Cc.`AA.-i�,v �`L--- �- \2- Date Filed: . v { (' j
**Ifyou would like e-mail notification ofsign off please provide e-mail address:
Owner Name: =�'1 ) Com& S
Owner Address: ` -pJ Q C,../ c_ le Owner Tel. No.:1/ 7 Z q j /3)
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: 6")?f\--11
DATE: 7
^ 1-2 --19•
PLEASE NOTE
COMMENTS/CONDITIO S:
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