HomeMy WebLinkAbout2020 Jan 09 - Sign off Transmittal - Extension of Rear Deck of:Y4A TOWN OF YARMOUTH
> c HEALTH DEPARTMENT
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�.e` PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: Ye"' v
Proposed Improvement: (")--r" c(c w b c c,,1 1 I w l'('-' v y---�. ) .1,.1 ''
Applicant: 1 G(1.0/ t T -- e Tel. No.:6 (`r 76 7 -5Q-1-
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Address: 1>'7 V" No f , r '0 i,- /1 Date Filed: -` .0 r-
**!f you would like e-mail notification of sign off,please provide e-mail address:
Owner Name: 4 L P i er,e A c�•c'�t C c� . /a i(..r'
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Owner Address: "1 (...fri ' 77S- 4'-'1, I.'?C/' Owner Tel. No.: 6 i 7" X ,LIC).- "f
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: :/7-------- DATE: I-- - °
PLEASE NOTE
COMMENTS/CONDITIONS: