HomeMy WebLinkAbout2019 Oct 03 - Sign Off Transmittal, Plans - Addition to Both Ends of House ,� TOWN OF YARMOUTH -
s HEALTH DEPARTMENT
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st- 3. , PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: 53 D/111/4/1:3012,V Ste' Y/00,1 oci.`/1
Proposed Improvement: 4i% /77%0?ki TQ gdrA 6341c1/5 a-f e>9 5T/41c 60 lice
it x 2 Lt
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Applicant: eiedoE1 ./ - 2Ai?40/Q Tel. No.: 40/ 8 ‘6c3
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Address: /CO S �UCQ L, IY f9J7l e hO(10 ill? 02703 Date Filed: /e�3�.3ij?
**lfyou would like e-mail notification of sign off please provide e-mail address:
Owner Name: 42/4 16 4 /2),4k# ),),(77 Ye/elk/le-5
Owner Address: 17/941 B(9RY S T Owner Tel. No.:
RESIDENTIAL AND/OR COMMERCIAL BUILDING
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements
For Septage Dispds'al and other Public Health Activities.
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Please sub it three (3) copies of plans,to include:
(1.) SitkPlan showing existing buildings, water line location,
and septic system location;
, Y (2.) Floor lan labeling ALL rooms within building
, • TM`s(all existing and proposed)
rft :Floor plans not required for decks,sheds, windows, roofing;
(3iF) f necessary, Title 5 application signed by licensed installer
` with fee.
REVIEWED BY: 107?-1---"y(dVDATE: /6/ 3//
PLEASE NOTE
COMMENTS/CONDITIONS)•
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