HomeMy WebLinkAbout2019 Sep 25 - Sign Off Transmittal, Floor Plans - Finish Basement I
of=7'4,4, TOWN OF YARMOUTH
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r c „HEALTH DEPARTMENT
. PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: „..)1 (ti fa1-vr:J j'L C`3C11-- T" \TA It !`a"'i k f 3 r
Proposed Improvement: 1 N k s 4 91 I,ti SF. O F P. o.5 t l t d
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Applicant: t AC. .hc-c ' ?bts, 11 -. to &—t' wit.`-1 Tel. No.: .5vb•71 l • (o3
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Address: 5 U ? .ti_`:, J G N c-a-- .'� ` a t r i�AN g t S i Date Filed: 9P-11-7-01,
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**lfyou would like e-mail notification of sign off please provide e-mail address: 1 N'Fo E'Ilk 1-\0‘..)S -• Com. Lin
Owner Name: �...>c..,F.:t4-^T i a t I.t.I p,...tj 4, 1,414,,/,10,4:71"
Owner Address: 2f1 64:.-.1\61--- -- S f t •p, 0,0)(--K Owner Tel. No.:9/4 4 Th,. * 3(.44,
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:
e, '. 7/2'r-711/ .PLEASE NOTE
COMMENTS/CONDITIONS:
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