HomeMy WebLinkAbout2019 Sep 30 - Sign Off Transmittal Sheet, Plan - Deck r TOWN OF YARMOUTH
^ . c HEALTH DEPARTMENT
'' ` PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: et Q ck (-)00, h A C ckot(
Proposed Improvement: ?)u w t ck;'e f,
Applicant: Jac I el(. Tel. No.: f�5 q L-1 S C)3)U
Address: Z C CcmtRooA VvA_Lto A (. & t Date Filed: (/ `7/ I et
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**lfyou would like e-mail notification of sign off please provide e-mail address:
Owner Name:
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Owner Address: Ci I1\v nnot;ltr.M P� Owner Tel. No.: 60 'Am (lei 340
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: DATE: t7 / 3c //,v,
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PLEASE NOTE
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