HomeMy WebLinkAbout2020 Jan 14 - Sign Off Transmittal Sheet, Floor Plans - Bathrooms Added el. , _ TOWN OF YARMOUTH
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' HEALTH DEPARTMENT
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wI` PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: ) L X tucc I fl c ,(:) ‘fl`A (`77,,,,,,6, j
Proposed Improvement: ' i t l Y ►to *a 0 a of t 4 i, IA
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Applicant: LA 0ov ---seit-cir Tel. No.:a Z.t 1 DOD-7
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Address: 12 GOA 4242(6Yc fii i \ Ill �y Date Filed: i ` ;Cal ,U
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**lfyou would like e-mail notification of sign off please provide e-mail address: 10+00\3*
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Owner Name: Leo,
Owner Address: 2r .X Y\ + 01
iir E\ r 0 Th ger Tel. No.: ?Z 6 ,i'
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, , windows, roofing;
i (3.) If necessary, Title 5 applicatikt signed by licensed installer
with fee.
REVIEWED BY: ill4
/ DATE: / / LI o0 ?G
/ PLEASE NOTE
COMMENTS/CONDITIONS:
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