HomeMy WebLinkAbout2009 Dec 30 - Sign Off Transmittal Sheet - Room Remodel ..�.—�. T______ . ,. _.r ,� �
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o,�° �''��y TOWN OF YARMOUTH
HEALTH DEPARTMENT
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PERMIT APPLICATION SIGN OFF T1tANSM1TTAL SHEET
To be completed by Applicant:
Building Site Location:_ a3 P��g �'�����G �°�,1�q �s C J q� Map No.: � �Lot No.:�
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Proposed Improvement: (�,�p� , �� �(oo�,�,�-r 1 �U c�cJ w�,c�n r� , C.�,n�t i��
Applicant: 4a�v n(unl� i��� �r�1� LC.:C_ Te1. No.: s�$-.38S-oo6�
Address: p,r`) , `� asc 7y-`� �. ,7j��;,�N� S DateFiled: /�.. a
**Ifyou would like e-mail rtotification ofsign off,please prwide e-mail address:
Owner Name: I�R i cc,(C n P✓����n ' -^ SE Ti, ,i,(,�� (
Owner Address: o� 3 p,,� , v� (�u, �S !,�R cJ Owner Tel. No.: So� 7�7-a�d,3
RESIDENTIAL AND/OR CObIMERCIAL BUII.DING
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements
For Septage Disposal and other Public Health Activities.
Please submit four(4) 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 eaisting and proposed)—
Note: Floor plans not required for decks, sheds, wixdows, roofrng�
(3.) If necessary, Title 5 application signed by licensed installer j
with fee.
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� REVIEWED BY: ���CGIGE-�r DATE: �Z � 'D �
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PLEASE NOTE
COMA�NTS/COND IONS:
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