HomeMy WebLinkAbout2008 Mar 07 - Sign Off Transmittal Sheet , Floor Plans - New House �* ..,��s.- �..-T--..�ws�F"Ac_.•-+:,.�.-,,.l��o,,.,�;,r_-.�.._-„ - r—•- A.,.�-._�.,-.--�.s.-a,..-"m��'_'�'_".'i�!.a...^�i^.�-�-��. .
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,�°��Y�� TOWN OF YA,RM4UTH I
o y HEALTH DEPARTMENT
��n�Tr� M �s �
�`°"""'» �'� pERMIT APpLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Locafion: �,3 ���1���; Map No.:��Lot No.:��;
Proposed Improvement: 1�..��;,,.t,,_'1 ��pH�
Applicant: ���_G.� �'����3���� Tel. No.: � 1:��. ��S t-��t�€�
;� Address: `�,`� ��;��� �''�'. � A�v►,�.1 + � Date Filed: 3� C�
**Ifyou would like e-mail notification ofsign of�;'please pravide e-maii address:
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Owner Name: ��:C�Q � �Cl t2"C�� ��,�`�'Ct'l,�i�
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Owner Address: �3 �1�L.?\ �E: �t�� Owner Tel. No.: �b8 �.�1 ��.4C,;j
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RESIDENTIAL AND/OR COMMERCIAL BUII.DING
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements
For Septage I�isposal and other Publie Health Activities.
Please sub�it four(4) cop�es of plans, to include:
(1.) Site Plan'showing ezisting buildings, water line location,°
and septic system location;
(2.) Floor plan Iabeling ALL rooms within buYlding
(au ezisting and proposed)— "
Note:F[oor plans not reqKired for decks, sheds, windaws, re,�fing;
(3.) If necessary, Tit1g 5 application signed by licensed'inst�ller
with fee.
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REVIEWED BY: DATE;������
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PLEASE N�TE
COMII�NTS/CONDITIONS:
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