HomeMy WebLinkAbout2012 Nov 29 - Sign Off Transmittal Sheet - Use & Occupancy �..,-� ,{ M�. _< -:�_. --� -� � . ...
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�oF��r,� TOWN OF YARMOUTH
� R w.i-�� I�EALTH DEPARTMENT
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�' ''���N�%�� pERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: � 1 J G� �J� ca�
L�J� �(c.r r mca►.,�t t� �'►n� Z�.2-67.3 .
Proposed Improvement: �,�,� p�- pt�✓�F'��'t Z.D
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Applicant: 1 P�t'�_L ��.�.L� Tel.No.: � ��- ' 7�� � $4?
i�n .�a�s- -�`�r- 3y 3� .
Address: �c+,n�e C,t� G.�cri� . Date Filed:�-�, l�
**If you would like e-maid notiftcation of sign of);please provide e-mail address:
Owner Name: �,,�,,.,. � .�,c��
Owner Address: Owner Tel. No.: t_.� �1.�- �(�,-�4 �,
............................................................................................................................................................................................................................................................................................................................................�....................
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 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: � ���� � �"� `}f
PLEASE NOTE
COMMENTS/CONDITIONS: