HomeMy WebLinkAbout2015 Nov 25 - Sign Off Transmittal Sheet, Plans .��,��� TOWN OF YARMOUTH
�� "-"�'j� HEALTH DEPARTMENT
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'''��N`` PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: f t k�L� �"��'
Proposed Improvement: �vi�t Ou Gr t'�72�G�f � /�-�/� ��j� (.,,� ,S
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Applicant: �{�� ��UU�1 C,t,+� Tel. No.: �l� 7 2/Z 8 f 0 Q
Address: `J� SpRfr���t�l�C /g L � �y�'r� Date Filed: � � �S /
**Ifyou would like e-mail notification ofsign off,please provide e-mail address:
Owner Name: U� l%� /Z��L
Owner Address: ���5,� �,S G/�1� ,,�`�'" � .��j�J�Q�,� Owner Tel.No.:
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RESIDENTIAL AND/OR COMMEYiCIAL BUILDING
� HEALTH DEPARTMENT: Detertnines Compliance to State and Town Regulations;i.e.,Requirements
For Se ta e Dis osal and other Public H
p g p ealth Activrties.
Please submit three (3) copies of plans, to include: ,
(1.) Site Plan showing existing buildings, water line location, I
and septic system location; �
(2.) Floor plan labeling ALL rooms within building
(all ezisting and proposed) —
Nqte:Floor plans not required for decks,sheds, windows, roofang;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
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REVIEWED BY: ` /1� DATE: ���'�`��/('� '
PLEASE NOTE
COMMENTS/CONDITIONS: � � '� i,
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