HomeMy WebLinkAbout2016 Jan 11 - Sign Off Transmittal Sheet, Plans - Attached Garage _ _ _ .
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o�.-'�q�e TOWN OF YARMOUTH
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Q� � � `�-i}� HEALTH DEPARTMENT
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PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be compdeted by Applicant:
Building Site Location: � � r r V
Proposed Improvement:_���C..��-�k� �S i h U-1 f�^_�.�wL G�-✓1 ,+3 G-/�L.
Applicant:�, ����/ /��K.c,_S-/-���. Tel.No.:,,�g ����{—l'1���
Address: s� C"�3 y G� a Sau�,� i�/'< <V 1'l. �s . �on�f-- Date Filed: C
**If you would dike e-mail notification of sign off,please provide e-mail address:
OwnerName: i'Ll-�,,�1%� �1�vz�f/��'�
Owner Address: .�,E3/�/� Owner Tel. No.: .���
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RESIDENTIAL AND/OR COMMERCIAL BUILDING
HEALTH DEPARTMENT: Determines Compliance to Sta.te 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 �ocation,
and septic system location;
(2,) Floor plan labeling ALL rooms within building
(all existing and proposed) — -
Note:Floor plans not required f�r decks,sheds, windows, roofing;
(3.) If necessary, Title 5 application signed by licensed installer '
wit6 fee.
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fREVIEWED BY: DATE: J �/ ��
PLEASE NOTE
COMMENTS/CONDITIONS:
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