HomeMy WebLinkAbout2015 Aug 31 - Sign Off Transmittal Sheet, Floor Plan - Case Doorway; Move Deck f_w _ _
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�of�R�?,� TOWN OF YARMOUTH
3 ' `'c HEALTH DEPARTMENT
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� '''^_^•`� � PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
� To be completed by Applicant.�
Building Site Location: �� �/9 y ��JQd2 y �`�
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Proposed Improvem • � C 2e C'� �r1 c�.G' �
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� ---tiPPlicant: L�U�� 13�s' ��/J��I�Y� r�/! G� Tel. No.: 5��/67 �l5
Address: 3� l�he /�� �fS/���'h ��eJ Date Filed: c, —� � —��
s•Ifyou would like e-mail notificatron ofsign oJJ;p/ease provide e-mail address:
Owner Name:_��/J�}7 �7( pUYt c�
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`'" Owner Address: / � jZQij�[�QCeJ J�-ye S LEl rf�'be.Tl� Owner Tel. No.: 6�f �jI ���
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� RESIDENTIAL AND/OR COMNIERCIAL BUII.DING
'` 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 eaisting and proposed) —
Note:F[oor 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: DATE:_ �/3 �// `
PLEASE NOTE
COMMENTS/CONDITIONS:
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