HomeMy WebLinkAbout2019 Jul 15 - Sign Off Transmittal, Plan TOWN OF YARMOUTH
- c HEALTH DEPARTMENT
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PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: 9 CRPT U ( (..... <. t• 1lr (311"
Proposed Improvement: 1 b IJ ( > \ . Fcr, L Y k TO STA n L-21 X l
1 vm i4'11 I-a c-42 on Tr .rj Q
Applicant: C-Y1V1' 1 Tel. No.: �.> 2 3 ) .J I b 5
Address:7 C ,� \10 0'2b31 Date Filed: 7 j `' 1 7
**Ifyou would like e-mail notification of sign off,please provide e-mail address: be-rt k r 2 + inn Al.L. c 0 Vhi
Owner Name: tr.,2abn O 1+:.. .-LAI
Owner Address: 2 C_ PtPT ) -irl Owner Tel. No.:6 (7
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;
(34 If necessary, Title 5 application signed by licensed installer
with fee.
REVIEWED BY: DATE: 7 r ' !
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PLEASE NOTE
COMMENTS/CONDITIONS:
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