HomeMy WebLinkAbout2015 Apr 02 - Sign Off Transmittal Sheet, Floor Plan - Repair Finished Basement .�F�R.y TOWN OF YARMOUTH
�{�$ HEALTH DEPARTMENT
�''�=`%� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: 2 ����� !r/GC �r.Of�
Proposed Improvement: ��—{'�9�12 �n�ST/�cJ� �N/SN L�i.�ifvr
Applicant I/13�+� �'i//1'f,SN" Tel. No.: 7�I i /�.5�(�
Address:_ L�� �1�����• (,��J /Y�tf �dZ/ DateFiled: �'Z/S^
**Ifyou would(ike e-mar!notrfication ofsrgrr off,please provide e-mai!address: �W�(�G�(-11S�OR •�'Orh
Owner Name: J(}l�hJ/r/dGG/S
Owner Address: Z �77�r�L1n� �JLC ,c,r. Owner Te1. No.:,S�� .371f�'l/�
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RESIDENTIAL AND/OR COMNNI�RCIAL BUILDING
HEALTH DEPARTMENT: Determines Compliance to State and Town 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, I
and septic system location; '
(2.) Floor plan labeling ALL rooms within building ,
(all ezisting and proposed) —
Note:F/oor plans not required for decks,sheds, windows, roofing; I
(3.) If necessary, Title 5 application signed by licensed installer '
with fee.
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REVIEWED BY: DATE: �— � � � �
PLEASE NOTE
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