HomeMy WebLinkAbout2019 Jun 27 - Sign Off Transmittal, Floor Plan Sketches - Change Garage to Family Room °'`•:= At TOWN OF YARMOUTH
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c HEALTH DEPARTMENT
kA:\Z .t/ PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: / r t ie °�_ re 1 'i
Proposed Improvement: Cq
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Applicant: A )DA N ---1 Ask '4 •-1 7 cin."'k64 Tel. No.: sag -3 4 17 92...A
Ca1frd' 6r,z?/ -244 [t' ii gig
Address: r g 4 *-u'S e k .. ., A 4 A^,cr Date Filed: ��4..---'ci f f.�71
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**If you would like e-mail notification of sign off please provide e-mail address: Cl i clbcij-Ino.^ k-, Ca 1 n.p---,-
Owner Name: SA on t_ A $ --._
Owner Address: Owner Tel. No.:
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)=
C. d *- Note:Floor plans not required for decks,sheds windows, offing;
(3:) If necessary, Title 5 application signed byelkcensed installer
with fee.
REVIEWED BY: i DATE: C - ).. ( C
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