HomeMy WebLinkAbout2008 Sign off Transmittal - Dormer •
° .YAC TOWN OF YARMOUTH
o , _yi HEALTH DEPARTMENT
'••" MATTA M
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: `". t � , ' `� ' Map No.: Lot No.:
GSI
Proposed Improvement: 1 v) E - / I ) t v/c r-
Applicant: . j ix hi Qut) t/t Tel. No.: (17" 7 rf "/c �o
Address: ( t ( ( ..,) 1 ` Date Filed: ((f/Of
**If you would like e-mail notification of sign off please provide e-mail address:
Owner Name: ` l11)0 VC
Owner Address: ( / ! ( l A .12,(), Owner Tel. No.:
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 four (4) copies of plans, to include:
(l.) 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.
1111
REVIEWED BY: AiG DATE: 7/1y c)
/ PLEASE NOTE
COMMENTS/CONDITIONS:
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