2020 Feb 14 - Sign Off Transmittal Sheet ot-'Y4k TOWN OF YARMOUTH
a HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
Tope completed by Applicant:
Building Site Location: �° h Jrs• i
Proposed Improvement: -+1 0 ( I G 1i I 1 b- G e vi Y' 7Y --c
ff e_Yrl4"c . W r tc.. c ivf c.-i-ricTA't . l 1
Applicant: '----v") /10 `1' �' CO i /'ll(Pt Tel. No.:
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Address: 2-- G ,1 (' I te 5 4 4-L -s Date Filed: iv 1-
**If you would like e-mail notification of sign off please provide e-mail address:
Owner Name: ! 0 f ? b'1 Ci b 1 eh/1 t�'"_`�....
Owner Address: 'l q p 1 (,s a k cf----- 5 y Owner Tel. No.: 50 ? ab T 7 y`
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:
ilA."17
(i27'#--------. DATE: 0.1./1 .X/ .
PLEASE NOTE
COMMENTS/CONDITIONS: