HomeMy WebLinkAbout2015 Aug 03 - Sign Off Transmittal Sheet - 4th Bedroom over Garage _ .� ��,�. _ _ ,
�.oF��e� TOWN OF YARMOUTH
�� a w��}� HEALTH DEPARTMENT
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� �''���N�'`� � PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
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Buildmg Site Locahon:
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Proposed Improvement: � � `-� '
Applicant: � Tel.No.: "'"�<�
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Address: U/� Date Filed: � '
**Ifyou would like e-maid notification ofsign of�j;please provide e-mail address:
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Owner Name: ;
Owner Address: �! ��wner Tel.No.: � '7y ,
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RESIDENTIAL AND/OR COMMERCIAL BUILDING ;
HEALTH DEPARTMENT: Determines 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.) Sfte Plan showing existing buildings, water line location, i�
and septic system location; ;
(2.) Floor plan labeling ALL rooms within building '
(all existing 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: C�G� � DATE: �''� ��
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PLEASE NOTE �
CO MENTS/CONDITIONS• '
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