HomeMy WebLinkAbout2016 Jan 21 - Sign Off Transmittal Sheet - In Ground Pool & Spa �o��q�e,,� TOWN OF YARMOUTH
0 6 `��}� HEALTH DEPARTMENT
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� ''�� N�``� � PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: 2� �'a`"R a�'`4 6 E C...��' ��M��� �`f��
Proposed Impr'ovement: ��l 6 kOv�l O � �-- � S��
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Applicant: �ClD�.WS�f I� �• I r.rC �`el.No.: gG�' '-Z�2-��q�
Address: � �'��•��C �D �r'G ..��c��R�ca �-1� , o�8��-- Date Filed: /-20—�G�
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**If you would like e-mail notification of sign off,please provide e-mail address:
Owner Name: ��"� l/1�l L..�
Owner Address: Z.� �t'�°�G.C� L..Oed�e Owner Tei.No.: �8�� g�-�Y�$-
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RESIDENTIAL R OMMERCIAL BUILDING
HEALTH DEPARTMENT: Deterrnines Compliance to State and Town Regulations; i.e., Requirements
For Septa.ge Disposal and other Public Health Activities.
Please submit three (3) copies of plans, to include:
(1.) Site Pla� showing'existin� buildings,water line location,
and 3eptic sy�'tem locati�n;
(2.) Floor plan labeling ALL rooms within buiiding
(aN ezisting and proposed)—
Note:F�r pl�s not required for decks,sheds, windows, roofing;
(3.) If necessary, Title 5 application signed by licensed instal�er -
with fee. � �
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� � REVIEWED BY: � � � � DATE:�� � d � ��? �
PLEASL NQTE
COMMENTS/CONDITIONS:
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