HomeMy WebLinkAbout2008 Sign off Transmittal - 8 x 10 Addition to Kitchen • TOWN OF YARMOUTH
o I! c. HEALTH DEPARTMENT
MATTAI
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: 3 S(%a,r,ne J Map No.: 3r, Lot No.:o04:2
Proposed Improvement: �'X /0 171 /, Gn H ��
/� /� � ,y r /6 1C.
Applicant: / f ISv Tel. No.: foe -237-
Address:
37-Address: 7 y'r�.,e tfie ��,/ — C c
-1 Date Filed: -03/61'
**If you would like e-mail notification of sign off,please provide e-mail address:
Owner Name: /1//44/1?-/ J/ 2
Owner Address: " 5 p iv/e Owner Tel. No.: Sod -1 c'-&i 7f
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: o�3/0 9
/ PLEASE NOTE
COMMENTS/CONDITIONS:
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