HomeMy WebLinkAbout2016 Feb 03 - Sign Off Transmittal Sheet - Covered Porch.....-�. . ..._ �..�.�..�_
}o��q�e,� TOWN OF YARMOUTH
- � t° HEALTH DEPARTMENT
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��"'���%� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: �'L ��--5��- ��� � —
Proposed Improvement: �� � x �] C_- v cJ�(''L�� �0 2 C.. /-( � ?V --�! QQ '
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Applicant: t/ °c..S �-e�-- �C��.l./�-e-- �� � �.,T`'{ �2 v.S�TeI.No.: �D� �/ Z 3 `�3�f �
Address: �vx 3 G (� ,�- ���?�� f"� �--( � Date Filed: � ' � � ��
**Ifyou would like e-mail notafacation ofsign off,pdeaseprovide e-mail address: �
Owner Name: 'S'/4'`��"' I�
Owner Address: 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: V��``��
(1.) Site Plan showing existing buildings,water line location,
and septic system location;
(2.) Floor plan labeling ALL rooms within building
(all egisting and proposed) —
Note:Floor plans not required for decks,sheds, windows, roofing;
` (3.) If necessary, Title 5 application signed by licensed installer �
with fee. �
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REVIEWED BY: DATE: � � /� `
PLEASE NOTE '
. COMMENTS/CONDITIONS:
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