HomeMy WebLinkAbout2015 Aug 20 - Sign Off Transmittal Sheet - Demo Left Side of House; Raise Right Side & Add Garage��.��-,_,.��-�.�-.--.��...�.,.� ._�. . �..�.
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oF=qk TOWN OF YARMOUTH
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o� ' ���y HEALTH DEPARTMENT
� '^�<•��� PERNIIT APPLICATION SIGN OFF TRANSMITTAL SHEET
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To be completed by Applicant:
Building Site Location: / S � � t � � 6 w ST � �S � �/�.(� �,d �'�it
��sed Imp o1vement: Wl O e � � � d� �t ✓�C�
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Applicant: �d S�4 ZT�+"� � Tel. No.: Sd C�4 Z L(3 �
Address: (n �( �V I�c�r � 17 Q� � ` �r/��- �tc.�! Date Filed: � �Zo — I ,S""
*"lfyou would like e-mar/notifrcation ofsign off,please provide e-marl address:
Owner Name: Gi 1' � u 1.� � � � 7�� �
Owner Address: � 5 � .S �. 3 Owner Tel.No.:
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RESIDENTIAL AND/OR COMNIERCIAL BUILDING �
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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,
and septic system location;
(2.) Floor plan labeling ALL rooms within building
(all ezisting and proposed)-
Note:Floor plans not required for decks, sheds, windows, roofing;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
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REVIEWED BY:��UC��Ir�/ DATE: �"�l'��
PLEASE NOTE
CO NTS/CO ITIONS: f / - �/
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