HomeMy WebLinkAbout2019 Jul 30 - Sign Off Transmittal, Photo TOWN OF YARMOUTH
- .40 HEALTH DEPARTMENT
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PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: 4 /2/74-0, 47 )„ PO4-6
Proposed Improvement: ,a1/VOI/L.Yr' T/1‹.-'2 (;4,4 6/40- ,/,?0(4ee
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Applicant: A-/ WM /11 Tel. No.: g4 ‘--77( 9127
Address: 41, ; 4c Date Filed: 7111_:-3(511
**lfyou would like e-mail notification of sign off please provide e-mail address:
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Owner Name: 0_ ,s? 0
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Owner Address: 82 //1-G*,',77,„( e).4-41 Owner Tel. No.: 92/ 119.`;.?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.
1
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: DATE: 7 — 0 —I 9%
PLEASE NOTE
COMMENTS/CONDITIONS:
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HEALTH DEPT.
-Colina Remodel-s�9o��e
FOR CONSTRUCTION
13 MACKENZIE ROAD, YARMOUTH, MA
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July 17, 2019
RECEIVED
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HEALTH DEPS: