HomeMy WebLinkAbout2019 Nov 13 - Sign Off Transmittal, Floor Plans - Convert Garage to Family Room ZO- Or --
ot-Y AN( 2- 8f- TOWN OF YARMOUTH E. 117, =J
.k.• - , , . HEALTH DEPARTMENT NOV 0 4 2019
•- PERMIT APPLICATION SIGN OFF TRANSMITTAL _ - Lni LTH DEPT.
To be completed by Applicant:
Building Site Location: q7 geaGcr\ ii S J1( Y�"-,G„
Propo a Improvement: Co A l/e� I ex- i 142i (3. i 04„ ! 7,-,,,nit .
`T 4 &red c -.1:-2f
Applicant:i6,,fc, de.7 Tel. No.:
Address: (,dc 'Gs1 -r ( I1( ,,,A 4-0.L .44- Date Filed: ///14
**/f you would like e-mail notification of sign off please provide e-mail address:
Owner Name: tar;‘,‘ 5 14'
/ v /
Owner Address: V7 £ cc.-, sL .f c 4 /u'^�.6/h Owner Tel. No.: Sd 3 7- 61 y r
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: 1C4\..,\_r------
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PLEASE NOTE
COMMENTS/CONDITIONS:
MAP NO. 7f fie/3 Zovp.JT A" .1 /draw
LOT NO. : /56 ADDRESS: 49' ..4,- r
OWNERS NAME: / 2/ J C,y. 7.--6, -- no
SEWAGE PERMIT NO. :0.1 3 FeNEW: REPAIR: x
DATE ISSUED:M-6-109 DATE INSTALLL�ED:/* -A7-42,0
INSTALLERS NAME: i'ie 3' - Com•
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INSTALLATION OF: ,,e,e_e '/
WATER TABLE: FINAL INSPECTION BY: 49VI4
DRAWING OF STALLATION ON REVERSE SIDE:
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