HomeMy WebLinkAbout2019 Sep 04 - Sign Off Transmittal, Floor Plan - Basement Water Damage de:YRit, TOWN OF YARMOUTH
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IltALTH DEPARTMENT
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•tzaztt--- PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
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Building Site Location: 6"5 stAvvc.—r--14V-e, i LA)' (Lor 1/1 ,3 „&,--). L 6,4-----
Proposed Im irov- ( ent: 't q t ( k-- - cAA/L-4-4---r A ac-\, cl:,,ie./ 41) .rah
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Applicant: Wt (1 t‘0 kV ht ce.,r
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Tel. No.50 3--7-7—7-7 C, ,
Address: - '( At r r c%I-, I--) W.17triiA-06 6, /44 6.0 64 R Date Filed:g g9 --/7
"Ifyou would like e-mail notification of sign off please provide e-mail address: •
Owner Name: Ski,1".... a
Owner Address: a... c.,...„.51,4,...c4 ,../f• L (fog--14-,..41 Owner Tel. No.cOS-360 -09 C (
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RESrTIAL AND/OR COMMERCIAL BUILDING
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HEALTH DEPARTMEN \T?1 Deterinines Compliance to State and Town Regulations; i.e., Requirements
For geptage Disposatind other Public Health Activities.
rfleaseNibmit tree (3) copies of plans, to include:
) She Plan showing existing buildings,water line location,
'--- find septic system location;
,;. , lo I !Ian labeling ALL rooms within building
( 11 exi ting and proposed)—
,te:Ft or plans not required for decks,sheds, windows, roofing;
(3.) I.- ecessary, Title 5 application signed by licensed installer
'.-- with fee
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REVIEWED BY:
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DATE: 7)// T
6/ PLEASE NOTE
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