HomeMy WebLinkAbout2005 May 11 - Sign Off Transmittal Sheet - Rear Deck ����a�.� TOWN OF YARMOUTH
�'� " "y'y� HEALTH DEPARTMENT
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'''*�M`-`' pERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be compdeted by Applicant.
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Building Site Location: C� (� �,^�[�C 1„� l ��. t t
Proposed Improvement: ,(��u� �, `j a � {�. (1,, � X +Z ,,� 1
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!` Applicant: � ��� C ��..T��, '��.v'�'� Tel. No.:��..�( L1(/ --�,�o/�
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Address: � ,�7 �j � � i�v .Q y t � rv _ (��FY 1-(/1 V t �'� Date Filed: / _
**Ifyou would like e-mail notification ofsign of);please provide e-mail address:
Owner Name:=�2 � c �t.a�h �9 j!� ..0 �� _
Owner Address: (,c„J (� 'R' ,�n ?� � _
� . i._� ��A� C P Owner Tel. No.: / �3�C ���
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,.� RESIDENTIAL AND/OIt COMMERCIAL BUILDING
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HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements
For Septage Disposal and other Public Health Activities.
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Please submit three (3) copies of plans,to`include:
(l.) Site Plan showing existing buildings, water line location,
and septic system location;
(2.) .�loor plan labeling ALL rooms within building
(all ezisting and proposed) —
Note:Floor plans not required for decks,sheds, windows, roofang;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
REVIEWED BY: DATE: S� (! �
PLEASE NOTE
COMMENTS/CONDITIONS,;,.
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