HomeMy WebLinkAbout2019 Sep 16 - Sign Off Transmittal, Floor Plan - Addition/Renovation {of Y Ak, TOWN OF YARMOUTH
//�; r. .r HEALTH DEPARTMENT
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sl° `'``fIJ PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: , B E3-€ SLIP c i i Aij — t1. T/ft/7 •
Proposed Improvement: i kg w yjr h e fLt cid j
Q op x . V /o 4446.1 '/C j/ AP 00
Applicant: JS e, . yPJ / 1 rf c.Y,,P^ 5 Tel. No.:,, —3 Pi,
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Address: 60 Kt, 1,f/` 1'/'7'o J 1 f M .11 Ph HA , Date Filed: 2 ,/`,(a p/ 7
**lfyou would like e-mail notification ofsign off please provide e-mail address:
Owner Name: U aiv N C A P/S'd Af ' I
Owner Address: A/17
4•- Owner Tel. No.:,6 Od<,f if ll.-On/ 7 7 ti
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.
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REVIEWED BY: " �^ DATE: 7/1/Cli
PLEASE NOTE
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