HomeMy WebLinkAbout2016 Jan 27 - Sign Off Transmittal Sheet - Alterations to 1st Fl. Bathroom and Lobby _ t.� .�.��_� Y�.� .�..�,.�.,�..� ,_
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�o�'�q�,� TOWN OF YARMOUTH
� ��i° HEALTH DEPARTMENT �U��
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�-�+��ACNE��` PERMIT APPLICATION SIGN OFF TRANSIVIITTAL SHEET
To be completed by Applicant:
Building Site Location:
7 SovT�c 5,ka-e z, Q .sr�i�, ss2'rt�
Proposed Improvement: iA/T�✓�Ti�i� '� ��9%7k�� ��o��L r S� '���`
Applicant: Ay'N C.' � �'% S/�/"i C'�c,�;7'r�TioiJ Tel.No.:�..3��3�a'fi�
Address:�� l�i�1�u/5 /..,�rt.J� C�//�'L� , /%f� 0...3.2�� Date Filed: d�
**If you would dike e-maid notification of sign off,please provide e-mail address:
Owner Name: �Irt^� �o,��J
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Owner Address: �����'�-°�'�� /n�bDk.°T��adhJ /�L Owner Tel.No.:
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RESIDENTIAL AND/OR COA�IIVIERCIAL BUILDING
HEALTH DEPARTMENT: Deterrnines Compliance to State and Town Regula�ions; 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 ezisting and proposed)—
Note:Floor plans not required for decks,sheds, windows, roo,fing;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
REVIEWED BY: DATE: I o'�
PLEASE NOTE
COMMENTS/CONDITIONS: