HomeMy WebLinkAbout2016 Jan 25 - Sign Off Transmittal Sheet, Plot Plan - Screen Portch C - �i 't
�o���c,,� TOWN OF YARMOUTH
� �.��}y HEALTH DEPARTMENT
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��''����`'� � PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Lo�ation: � � /���i �
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Proposed Improvement: �(o,2�2�J 13�L '� -� X j(p'f7
Applicant:`�,a.�, �n—�o,r (.G�1212�,f.,/ Tel.No.:__,�U�" �.�`t�
Address: t ��w� = - ►2 Date Filed:
**Ifyou would like e-mail notification ofsign ofj,please provide e-mail address: ��(�,} ��� ,Q�O,�i1D�
Owner Name: .. .F'l� !�,-�,,��r>>d�, l�l d�S
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�: Owner Address: q.� + �,j ��-�ti� ,�-L�'i Owner Tel.No.:_� =� =- �lj
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RESIDENT��I,AND/OR COMII�RCIAL BUILDING
HEALTH DEPARTMENT: Determines Compliance to St�`ite and Town Regulations; i.e., Requirements
For�eptage Disposal and sother Public Health Activities.
Please submit three (3) copies of plans, to include:
(l.) Site Plan showing existing buildings,water line loeation,
and septic system location;
(2.) Floor plan labeling ALL rooms within building
(all ezistin�-and proposed)-
Note:Floor plans not required for decks,sheds, windows, roofing;
(3.) If neeessary, Title 5 application signed by licensed installer
with fie.
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REVIEWED BY: DATE: � O� � ��
PLEASE NOTE
COMMENTS/CONDITIONS:
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