HomeMy WebLinkAbout2019 Aug 06 - Sign Off Transmittal, Plan - Small Deck "66ooRAt,� TOWN OF YARMOUTH '
5c HEALTH DEPARTMENT
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rMPERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant: �(
Building Site Location: /It :: hi. Loc k W Y / f , '"i`�p' ‘''N or
Proposed Improvement: S01 a eitec k +., &e c,t.,, (4, o t f v'ilr f L - col( j
sires if' i 4>r,e
Applicant: S fe \: 11 G c,.r Kr r Tel. No, 7 `I ` ')C ` 7 ?i l
c4,tem, ,t e rt i''`-'c'' ✓ 4
Address: Cr', s^�. [3e p, 75 Yrr vi3w t-, c n O r tI A 0 2 r I Date Filed: / 5'i 1 9
**Jf you would like e-mail notification of sign off please provide e-mail address: 41 t'rL a 't'J 6 1 t''`I A I . C•75"-1
Owner Name: < i' . f ' vo 6 r
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, MA
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Owner Address: -�7 c 1� Lat4tyrry tr -1at-i1, lac Ow2ner Tel. No.: ] 7-1 -7 -;-/' . 1 1 - I
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 i
with fee.
REVIEWED BY: h...\-..„--iy--
DATE: e / +
PLEASE NOTE
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