HomeMy WebLinkAbout2017 Oct 10 - Sign Off Transmittal, Flloor Plans - Basement Rooms . f R
I TOWN OF YARMOUTH
/� °` HEALTH DEPARTMENT
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ZE.i. PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
tyo be completed by Applicant:
(Iltuilding Site Location: 1" jS ANcd" �.�w`
Proposed Improvement: Ci. a w\5 t Tt\.ja—N
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Applicant: 64i uo g"' eike..SC—$2,/ Tel. No.:soE5 a5O
Address: 4-5, 'b AU ' 'A yu."...rrog ‘•" ,-- Date Filed: /O//O
**Ifyou would like e-mail notification ofsign off please provide e-mail address:
Owner Name: ' 4`" 1► «
Owner Address: s"(% "I>144 As N=LR Nc.0.11 ii+-2`~.. Owner Tel. No. '? Zaii Q S
RESIDENTIAL AND/OR COMMERCIAL BUILDING
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations;4.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: /CV/0//7'
PLEASE NOTE
COMMENTS/CONDITIONS:
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To be completed by Applicant.-
Building
pplicant:
Building Site Location:
Proposed Improvement:
TOWN OF YARMOUTH
HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
81-r11 /'J s7
Applicant:
Tel. No.: 5,;1_ -
Address:J/6
_j),grJR5
p0t7�7 IV, yl-lIQ_ nou4h', %fitcl
Date Filed: *GZ17
"Ifyou mould like e-mail notification ofsign off, please provide e-mail address:
Owner Name: E-.bWAi2`O _01A[gT-1 L.E
Owner Address: / 9 Tm N /i S Pa id/, �y• f� trtOeiT!/, %,%1 Owner Tel. No.; _5i)ff - �. 5S' ` f 66
F!Ml .A=
TH DEPAR NT: 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,
Uand septic systern location;
rt.J (2.) Floor plan labeling ALL rooms within building
(all existing and proposed) —
J w f \ Note: Floor plans not required for decks, sheds, windows, roofing;
(3.) If necessary, Title 5 application signed by licensed installer
�tl with fee.
REVIEWED BY: Ll-',•�f � DATE:
L' PLEASE NOTE
COMMENTS/CONDITIONS: /
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HEALTH DEPT
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