HomeMy WebLinkAbout2017 Oct 17 - Sign Off Transmittal, Locus, Sketch - New Foundation � v ti�
o Yqk TOWN OF YARMOUTH
c HEALTH DEPARTMENT
-
``�f PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: 3( QQ /7cf
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Proposed Improvement: /Ve , fctiHG ani G r7
Applicant: Dqu i� /7'a 1-1 f Tel.No.:
Address: 7.,f0/1/416.-// Set- )L Ay,/ Date Filed:/�'/`7 /,
**If you would like e-mail notification of sign off,please provide e-mail address:
Owner Name: W/,tL ee4e 7 AlC/i-7cb;cT7
Owner Address: ) 12-. r;)-- 7`165-r S'1 ) (.)r r4Owner Tel. No.: 7a/ Z cs 7c
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.
REVIEWED BY: fp , DATE: /6// 7
PLEASE NOTE
COMMENTS/CONDITIONS:
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PLAN OF. LAND IN BARNSTABLE AND YARMOUTH •9VjO°
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• Nelson Bearee, Surveyors
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