HomeMy WebLinkAbout2007 Jul 06 - Sign Off Transmittal Sheet, Plans - Enlarging Kitchen, Dining Room . _
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,�°��Y`���o TOWN OF YARMOUTH
o _ ` . ,��, HEALTH DEPARTMENT
N MATTA N ESE �
��`°"""""°��c� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant: y
Building Site Location: �� �i(/�'��� Map No.: J ��Lot No.�
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Proposed Improvement: ,�� S �i� � G�
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Applicant:��� ���(f�x�J Tel. No�l,�''�''���y� �
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Address�� ,i� Date Filed: `'�S '�(�
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**Ifyou would like e-mail notification ofsign off,please provide e-mail address: �'°�`�7 '""!' '�'SS'r-�C � U� ���'� '
Owner Name: �"'�`t-� ��
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Owner Address: ,�,1 G'p�/�.-��-1-?�� l Owner Tel. Np���"���-�' �g
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RESIDENTIAL AND/OR COMMERCIAL BUILDING i
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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 four (4) cop�es of plans, to include: j
(1.) Site Plan showing ezisting buildings, water liae location, �
and septic system location; ;
(2.) Floor plan labeling ALL rooms within building i
(all ezisting and proposed)— j
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: ��� �t,� �C��C'�i' DATE: "��`d 7
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PLEASE NOTE
COIVIMENTS/CO��TIONS: . � �
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Yarmouth Health Department
APPROVED
- Date 1