HomeMy WebLinkAbout2015 Jul 27 - Sign Off Transmittal Sheet - 12' x 16' Rear Deck _
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�,o�'��r,� TOWN OF YARMOUTH '
� � �O HEALTH DEPARTMENT
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� 4~��'��NE�y� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: � � 5(�����-�. j�f� �' �;� "h-i ��Y� d� (
Proposed Improvement: �Z X �(c� t���� �� � Pv Z � �'- 1`�'C7 v S L
APPlicant: � � C �}t-���- S ��'/��� Tel.No.: "? - 3 � -Z �(c�
Address: Z� 61�,J '�-p� r �Pc'4� ��'Z� �c�tJ �C,� fM}� Date Filed: 7 � /
**Ifyou would like e-mail notification ofsign of,�;please provide e-mail address:
Owner Name: ��{-��t�- . ASS��
Owner Address: �- � �-�(�P��t��^l�' ��-6n tt�o�.the�dl� Owner Tel.No.: �'�`�J' -c.:�7- Z)`T�
RESIDENTIAL AND/OR COMMERCIAL BUII.DING j
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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 incl�de:
(1.) Site Plan showing existing buildings;wate,�-iine location,
and septic system location; • `� �
(2.) Floor plan labeling ALL rooms within liuilding` ry
(all ezisting 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: f DATE: < �
PLEASE NOTE ' _ -
COMMENTS/CONDITIONS: � - �