HomeMy WebLinkAbout2019 Jul 15 - Sign Off Transmittal, Floor Plan - BR and Bath addition on Sona Tubes of if TOWN OF YARMOUTH
s; tHEALTH DEPARTMENT
o. -i
w,".A PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant
Building Site Location: N I ni,o 0 /le o" ,cx 1 Or 1. .
Proposed Improvement: 1 c co,,, -F j 0- k-o(,,-,, Odd;4;0r) C 'S0 t S
Applicant: 4 rn ,., h c r Tel. No.: 50 - 3(10-/)6 j/
(y�?{ �;�`,�
Address: 7 I iotle ck--'o 4� C)lc a c� Ac e'k, AA O 10) Date Filed: 7- 15_/ci
t
**/f you would like e-mail notification of sign off please provide e-mail address: TA i L i i,}3 a>1 716 " �f 0-10;I. co,,)
Owner Name: 1111 - Hca r all Jo k)50 0
Owner Address: 7 4 ,01:JE(aDos-) 010 bl ,ALLL .' i A("1 0150) Owner Tel. No.: 6 0' 36/0 -76 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.OwThY"V,-k
l ,�
REVIEWED BY: DATE: /......._ 1/4
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PLEASE NOTE
COMMENTS/CONDITIONS:
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