HomeMy WebLinkAbout2015 May 12 - Sign Off Transmittal Sheet, Floor Plans - Water Damage Repairs �o���� TOWN OF YARMOUTH
- � �O HEALTH DEPARTMENT
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�'�''��E`%� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be compdeted by Applicant:
Building Site Location: �/ 1 '� `C� 1 � o�`�'�
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Proposed Improvement: �r.'�'c�ilollL. �.]p►r�Y�..�.,,,�o�����G���,,,�", e� St���+�'i"'rt.oc.t�.. u��t�
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Applicant: w�u. ,.. �l�lL.� ��v Tel. No.: �'��QQ t 5 1 /
Address: i�'1 (�ir�c� 3~T t�$ R�,)ST..''Y\.._ Date Filed: '�=E�, -(�""
**Ifyou would like e-maid notafication ofsign ofJ;please provide e-mail address:
,Owner Name: ��t�,��R u t�1�t N
Owner Address: 'P� � 0� 31 Sr ��'��3��2..1� Owner Tel.No.: SrO�S 7 3 7 �7(,a
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RESIDENTIAL AND/OR COMIl�RCIAL BUILDING
HEALTH DEPARTMENT: Determines Compliance to State and Town Regula�ions; i.e., Requirements
For Septa.ge Disposal and other Public Health Activities.
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.
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REVIEWED BY: DATE: S 1 ! �
PLEASE NOTE
COMMENTS/CONDITIONS:
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