HomeMy WebLinkAbout2016 Feb 16 - Sign Off Transmittal Sheet, Floor Plans o����e� TOWN OF YARMOUTH
�� -� W��� HEALTH DEPARTIVIENT
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��'��E``� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: ��� �/�S/O�cJ l!t �� • ��m�'''" �
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Pro osed Im r vement: A .� A��� a� h`� �/ t�� �vin
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Applicant: /�ic h�G� i�En� Tel.No.: �t��� �7��
Address: .�Aml° Date Filed: ��-��^�d
**If you would like e-mail notification of sign o,fJ;please provide e-mail address:__�C/I!,{C�CL�/�A� � /7'1�': CD M
Owner Name: '�"!�/� �
Owner Address: Owner Tel.No.:
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RESIDENTIAL AND/OR COMM�RCIAL�3�ILDING
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., �equirements
For Septage Disposal and other Public Health Activities.
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Please submit three (3) copies of plans, to include:
(1.) Site Plan showing existing buildings, water line location,
and septic system location;
; (2.) Floor plan la6eling ALL rooms within building
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(all existing and proposed)—
Note:Floor plans not required for decks,sheds, windows, roofing;
(3.) If necessary, Title S application signed by licensed installer
with fee.
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REVIEWED BY: DATE: � �,
PLEASE NOTE
COMMENTS/CONDITIONS:
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HEALTH DEPT.
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