HomeMy WebLinkAbout2007 Sign Off Transmittal - Farmers Porch 21; 4o, TOWN OF YARMOUTH
• HEALTH DEPARTMENT
o
••� MATTACH ESE ti'g
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
-To be completed by Applicant: /7
Building Site Location: 3,3` 10,-)f f Ry c. 1,9 hr,b r k Map No.: Lot No.:
Proposed Improvement: -J / �... o�. 7 t / 4 f Alert o/'c g 7 O
/ p " o 1)�
I J
Applicant, ko /14;pcx- J A N ti€ Tel. No.SO 5- 30-/// ---
Address:
vf///2"'Address: /d 0 So g;i1, 9W, "/`'yQ f / Date Filed:/0,1 107c:7
**If you would like e-mail notification of sign off please provide e-mail address:
Owner Name: Ja e 0 e e
Owner Address: 35 fir_l c�% /�o SC /P� AC - 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:
(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: / L1' �/'(,e,� de:4,67 4` DATE: /2
PLEASE NOTE
COMMENTS/CONDITIONS:
X � S; /di/4... //�// 'i 1 S�/ //1a11 /9 c..e "'It /% ,
c/o 1 �, 5- G'/� /
Y
i
tJEI� Apr�ITia�
p