HomeMy WebLinkAbout2009 Sign off Transmittal - Deck TOWN OF YARMOUTH
y HEALTH DEPARTMENT
'1•` MA;TA H ESE
'U'*'' PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: q En 6a fry In, /41'Ma k.1i ,v(-T Map No.: Lot No.:
Proposed Improvement: NYI.,f c — I a. )‹ c y-
Applicant: Cti a IC r J, V‘t i //Q N G 014�-f Tel. No.: 5-6 r-3 7 C - 77 Y3
Address: 3 L/g P14,n ST ii, , 1 I► s /11 a. G 01 o S 5, Date Filed: 3/z GU 7
**If you would like e-mail notification of sign off,please provide e-mail address:
Owner Name: C h a r/t s (.7:- Vet I` //a H to u r-r
Owner Address: Owner Tel. No.: _-/9 ni E.
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: DATE: 3/dchc7
PLEASE NOTE
COMMENTS/CONDITIONS:
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