HomeMy WebLinkAbout2019 Oct 25 - Sign Off Transmittal, Plans - Addition 0v Y ,y TOWN OF YARMOUTH
;. . c HEALTH DEPARTMENT
• ±'' :� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: / j 1 1 Ufte 1 11 T ,s
Proposed Improvement: 1 & OA . , A j
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APPliCaniArn n&I( ," 1)anc 1, 0 Va.
nel. No.: m L 0 _p '
Address: 67,) 3 ti,,,..., „, -I .-
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**if you would like e-mail notification of sign off please provi a -mail address:
Owner Name: ' ,/t./44-e-
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Owner Address: Owner Tel. No.:
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;
(34 If necessary, Title 5 application signed by licensed installer
with fee.
REVIEWED BY: DATE: 4 i?
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COMMENTS/CONDITIONS: , j
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