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HomeMy WebLinkAbout2016 Mar 21 - Sign Off Transmittal Sheet, Floor Plans - Finish Basement for Daycare �o�'_�-'�a�,� TOWN OF YARMOUTH � p-`���y HEALTH DEPARTMENT c:-�;. �, ��''���NE`'` ' PERMIT APPLICATION SIGN OFF TRANS�VIITTAL SHEET To be completed by Appdicant: Building Site Location: � �C�t�✓� �(�• Pro�s d Improveme t: ��2�'� T1�C..�` I� � (� �Q C�i�iC' 1�Q.,�,� /�(J - f y�/1 -- ' C ct�c 'a 41 7�N J oG�^�l' .,�/ � Applicant: ��'c n i �'►��l�'" Tel. No.: � --6 G� ,, / n�+ 1 �_ ( G�qc.l� -'''j-��- aiQ Ad�clress: � �y ��✓�1 �C�P�� {�1. C7�Gt�fitJ��l��/� (�l�o�!� Date Filed: 3 t W r`^ **I�you would like e-mail notafication ofsign ofJ;please provide e-mafl address: �C'C,tY1 Tr'�����'��� (��/�j�1Q%',C"Qm OwnerName: /��/Vlqi� a ����i��S Owner Address: � �w✓1 ��, Owner Tel.No.:�D — — �',?,. ................................................................................................................................................................:.................................:.........................................................................................................................................:..................... RESIDENTIAL AND/OR COMMERCIAL BUILDING 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 showing existi�g 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 necessary, Title 5 application signed by licensed installer with fee. ..........................................................................:................................:...................�........................................................................................................................:...........:.............................................................:..................................... REVIEWED BY: DATE: � � �'� I� r+� PLEASE NOTE COMM TS/CON ITIO S: , �-- �v5e � ��v+� �-c �. ,� I��v�o � -- c,� Z.�T j"(c��.. /"�v S 1 K v@- � -1�- ln Si4 '�`` i C�e�.5� i G� �,l G�a� , �„ �Q� �1�1 +�` i�1 �I .�i �I2i Zi �;�� �, i �iS�1-i; �y! 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