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HomeMy WebLinkAbout2015 Aug 10 - Sign Off Transmittal Sheet - COC , _ _n . __ p �,�.,..,�;, ; , � !�I f�A,�,� TOWN OF YARMOUTH i g�02 �'a� HEALTH DEPARTMENT �:,� r s �� � ''��^``� � PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET s—(w 'o completed by Applicant: v� Building Site Location: �� �/�) �1�� /� �� Proposed Improvement: �ri l . ( � i i Applicant: V�'�Y l.Rk�;� ,c,"; `� - ;� �tC C��;� �2�SrnN2i f Te1. No.: ��'� �-v-'� � Q"nrqr�N� M - ('7A,E: V�) 1 Address: /i> 9� 2 r a X ��vr,�r� ��A Rm 6��-N �� Date Filed: ��O f i •*Ifyou would like e-mail notifrcation of sign o�;please pravide e-mail address:lC�a�P 2M Q � � G p(11 d�� ( )).�- r�) ,/ �WReI'N8iri0:/1 � Ct`"1 /('r.�/f�/ i/�J`� IOwner Address: �r� ,(.�si/� 1��i�r n S� Owner Tel. No.: :'�"� .��i' /�'1.S � RESIDENTIAL AND/OR COMNIERCIAL,BUILDING � HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements For Septage Disposal and other Public Health Activities. iPlease 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 existing and proposed) – Note:Floor plans not required for decks,sheds, windows, roofing; (3.) If necessary, Title 5 application signed by licensed installer with fee. _................._........................_........................................................................................................................................................................................................................................................................................................... REVIEWED BY: ( (J�/ � DATE: �'%D"/� PLEASE NOTE COMME TS/COI��TIONS: /`� il�O=j � JT- l�� ���G/Ul� t�,