HomeMy WebLinkAbout2020 Mar 06 - Sign Off Transmittal, Floor Plan 4.
:Y t o TOWN OF YARMOUTH
.,c HEALTH DEPARTMENT
3,
` PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant:
Building Site Location: Z A6-1) (k. c.oz w�u, k� / ?A
Proposed Improvement: ::� ea 0 0-1 te- .. A,rc_ \
V Applicant: :----:-„R (G (j^ , D i E: (x Tel. No.: o2 57 `3 7` c;s
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Address: ‘C \ el. . Qt' c' 1411/156)2 6 6 Z Date Filed: z / . 7/20 r 4)-
**Ifyou would like e-mail notification ofsign off,please provide e-mail address:
Owner Name: 7 - c a 5 C.--:, c,4 ' o 't_
Owner Address: , „ " 'A ,t,, ^,, 0. X,,,,t,, --(' Owner Tel. No.:3/# -.372i — Sc 9‘
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• 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: 3 �o id-�`'
I. PLEASE NOTE
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