HomeMy WebLinkAbout2016 Feb 24 - Sign Off Transmittal Sheet, Plans - Three Season Room � •
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�o���e,� £ TOWN OF YARMOUTH
-- `��o �� HEALTH DEPARTMENT
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�' '`���M�%� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant: -
Building Site Location: �-. �
Proposed Improvement: f R L✓ �T/�
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Applicant: i Tel. No.: (� � (�j
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Address: � �-t • f1�� ate Filed: �2 �-�� ��ta
**Ifyou would like e-maid notification ofsign off,please provide e-mail address:
Owner Name: �f J � � � 2 �9'°�`� � -��
Owner Address: r Tel.No.:
..........................................._.....................................................................................................................................................:...............................................................................................................................................................
RESIDENTIAL AND/OR COMIV�RCIAL BUII.DING
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements
For Septage Disposal and other Public Health Activities.
Please submit three (3) copies of plans, to include:
(1.) Site Plan sbowing 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 necess�ry, Title 5 application signed by licensed installer
with fee. '
................................................................................... ................................................................................................................................................................................................................................................................................
REVIEWED BY: DATE: �-- � '
PLEASE NOTE '
COMMENTS/CONDITIONS:
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G,�.�E IN�P��Tl��1 PL
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:�ef����'� �tood panet.• 2�0 o t 5 o a� 7� �(ood�or�e:�4 � � �
9 hereby tertif tl�qt this mor�gr� e irts ectiovt wcts prep�red for � N0'
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C�ie dwelting sGrow�r hereon : 5 � alt i�r a:specia! �.�.M.,4._flood zone
y4"or"'V;with avt effective date of �2- 2 a�rd tl�e IacatioK of the dwelling
--�conforn�t to the focral zoMi�rg by-�aws in effect at the time o cort-
t f Scale.�1"_ 3�s`
structiah with respect to Morizonta!dime�tsio�tcrt setback requireme�rts or ��t�.��-
rs exempt from violcrtion enforceme�ttaction u�derlVl.G.L C'h.�iQ�l,sett.� ;3ile�o.1�:- 0��2 1�..� ,
please note.•`the structures shown on this martgage inspechon are shown appro�imate only.,4n instrument survey is necessqry tr�de-
termirte a precrce toCation of structr��-es Andp rvper�ltrres.2'h�s morfgage in on mustrrot be used r recordin
preparing deed descripiions and mustnotbe used" r° 9�+!�ses or farusein
ery�rnedimensions. f�'variance or burtding�i-tment pu 1/ert�tcctit'on of 4�wrldrng[octrtt'orts,prop-
fences or lotcarrfrgurcttion can onty beAaorrtplished by qrt acturate ins�r�um nt sur►�ey tvhich may re/lect differerrt rn-
fcjrmationthanwhatisshowrrhereon. Np-�E; -t-NlS!S NOT A BOU�ARY SURVEY AT•1D 1S FOR M�RTGAGE PURPOSES ONLY. '
COLONIAL LAND SLIRVEYIi�I� COI�I;P�.NY 11�1
269 HANOV£R STRE£T • HA�IOVER i+AA 02339 • PHONE:78I-826-7186 • FAX:781-526-4873 • COLONIALSURVEY�'dGMAiL.C�+
T.��MS
Job No. Sheet of
Project �l'�O`.C..t'{' �--Y'�N � S p 1� (�`� ��6Q A�I C t' �E-'� Date
Subject By
Ch'k.by
� RECEiVED
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F�� 2 4 2016 �
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