HomeMy WebLinkAbout2014 Apr 24 - Sign Off Transmittal Sheet, Floor Plan - Use & Occupancy }o��AR,� TOWN OF YARMOUTH
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� ''���M�`% � PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: �' - f, ' �Yt- �-C.- � �-�` �,.��� �� �2 f���.
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Proposed Improvement: (...��V�'n��--�c �>�� �
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Applicant: �1 : � C ��. Tel.No.:'>c�- ��o -(:a5 Z3l
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Address: �c,�r �c�'�"�����`�r.: �_C - ���,� 1��,.�����.� l�-�;� J?��y Date Filed: �/ ,. 2. 1, .)�i t�
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**Ijyou would like e=mail notification ofsign off,please provide e-mail address: � (._ ��s'y*��i7'/���`e (� �7�� ���ct`/ ��U'� .
Owner Name: F�;�"�'.$ ��'. �.,-e,,,
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Owner Address: � �' � � ���rr� ��`� ���� G�;�.��� � � G� CJ�� wner Tel.No.: S�.�fs -2���-��1 �S� �
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RESIDENTIAL AND/OR COMMERCIAL BUILDING
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulafions; 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 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.
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REVIEWED BY: � DATE: �
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� PLEASE NOTE
I COMMENTS/CONDITIONS:
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