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HomeMy WebLinkAbout2015 Apr 21 - Sign Off Transmittal Sheet, Floor Plans �;d'�;;a!?.� TOWN OF YARMOUTH �' -� `�'}°�c� HEALTH DEPARTMENT s.� �, �'�M�MCNE%'�' PERMIT APPLICATION SIGN OFF TRANS1t��TTAL SH�ET To be completed by Applicant: Building Site Location: � �-2 1 `��� � �(�-�-- � Proposed Improvement: � w�,0�,i �"�t O�..S�..- �a��t7'✓1 � C�, 1 {' Applicant:��0 �, • M Gvl �'1� Tel. No.: �U� 2 -3q �?j Address: �� M �`�.�v I Date Filed: �...� 2 U � �J **Ifyou woudd like e-maid notification ofsign o,f);pdease provide e-maid address: Owner Name: h IrU► `� M C l OV�,� Owner Address: � `,�.,11�t. 1,6L Owner Tel.No.. q� �5 `Z� �1� 2. RESIDENTIAL AND/OR COMMERCIAL BUILDING HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements � For Septage Disposal and oth.er Public Health Activities. I 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 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. , �' ............................................................................ ................ ..... ................................... ...................................................................................................................................................................................................................... ; REVIEWED BY: DATE: L � f ; PLEASE NOTE I COMMENTS/CONDITIO S: � i v S," s�,.�M�T ��cJ S-� �``r `� "f'��E' L u e a-� �.0 ; ; ���n � /`- 1� Uccu �q I � �