HomeMy WebLinkAbout2015 Jun 19 - Sign Off Transmittal Sheet - Deck 04 rqR,� TOWN OF YARMOUTH
o��)-Gi HEALTH DEPARTMENT
���=��� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: �� �u►.�N S T6v�e �1"� .
Proposed Improvement: i O �� � f�lL
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Applicant: C'./��EZt) ci'�� � iU�'E�iP�iS�c S L�-C Tel.No.: S��S �7' $ � "7 7
Address: /S3 C��ywvr�r�.0 la L 5 f" i'YI�5�PE� Date Filed: <n /�l � -
*'IJ'you would like e-mar!notrfication ofsign o,JJ;please provide e-mail address:
OwnerName: (.Ec>�C �,ep,e�� ;
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Owner Address: �F c� �c�aJ e g rp-yt C 1...°D • Owner Tel.No.: 568 6 � 9 I
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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 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:F[oor p[ans 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: i DATE: 6 — / 'J�-/�
PLEASE NOTE
COMME�/C/d��OY� sY/ i1..0/IDS/� /h`" �'[A2/�/- ��