HomeMy WebLinkAbout2015 May 21 - Sign Off Transmital Sheet, Plan - Closet Addition 2oF�'9R,4 TOWN OF YARMOUTH �
3�c HEALTH DEPARTMENT
��"'"<��`' $ pERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant: �
BuildingSiteLocarion: 7 G✓���`e �7`�e- y►9�-C��PG��.� l-�_ ��✓}r
Proposed Improvement: ,l�Q.W Sx � C �CLf e"� �}QD f'�'� O d..J
Applicant:� �`�{�f' P��I �►-� Tel. No.: �v�-�,�`�' o a s'6
Address:��� ���� l�-�✓1� Cet-�``r"' ��� l�^✓� ��Z Date Filed: S 2� i�
, **//'you w !d Irke e-mail notifrcatron of srgn o,�;please prwrde e-mail address:
�� r Nazne: J 19�lJ �o ufl e ��
Owner Address: 1 3 ✓� 5�ei�`' C`�"2� Owner Tel. No.: ��v' 1�D d •/g S�
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RESIDENTIAL AND/OR COMNIERCIAL BUILDING
HEALTH DEPARTMENT: Determines Compliance to State and Towri 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 p[ans not required for decks,sheds, windows, roofzng; _
(3.) If necessary, Title 5 application signed by licensed installer
with fee. •
REVIEWED BY: DATE: ) �/
PLEASE NOTE
COMMENTS/CONDITIONS:
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No.20487 O Q
Ado FsS ONAG�a
r
.. q, a�ol
Donald W. Moncevicz, P.E.
Civil Engineer
40 Pond Street
West Dennis, MA 02670
---394-05'09
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MAY 21 2015
HMTH DEPT.
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