HomeMy WebLinkAbout2015 Sep 02 - Sign Off Transmittal Sheet, Floor Plans - Extending Bedroom �--�--�--� - _ _. : _.,.,�....,�„fn.� . _,, � ,
=oF;qR,y TOWN OF YARMOUTH
� - �� HEALTH DEPARTMENT
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� ^�=•�d � PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: �/ L.�W�� �c.�^� ��-�`-
Proposed Improvementc ��� ���� ��� �''���"C/
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Applicant: l/�O��GL�� Tel.No.S�=`/�?D� �/��7�
Address: � 7�� ��� ��� /"�/ ����ate Filed: �✓�
*'Ifyou would lrke e-mail notification of sign off,please prwide e-mail address:
Owner Name:j��� ���y
Owner Addres • � � �-�"� � Owner Tel. No.: '
, _w�..-.��_._-�_..�_.�1��� ...._...................... ..... '
- RESIDENTIAL AND/OR COMhIERCIAL BUILDING '
HEAL1'I-I DEPARTMENT: Deternunes Compliance to State and Town Regulations; i.e., Requirements ',
For Septage Disposai 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 egisting and proposed) - ,
, Note:Floor ptans not required for decks,sheds, windows, roofing;
(3.) If necessary, Title 5 application signed by licensed installer
wit6 fee. '�
_..............................................................................._......................c..................aC�'F;�............................................................................................................................................................................................... I
REVIEWEDBY: DATE: �/'� /S� I
PLEASE NOTE
COMMF�N"I'S/CONDITIONS:
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Yarmouth Health Department
JJPPROVED
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14iime Date
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