HomeMy WebLinkAbout2012 Mar 21 - Sign Off Transmittal Sheet - Use & Occupancy �,a��'?,o TOWN OF YARMOUTH
�'� �j� HEALTH DEPARTMENT
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`"`'�-=M``�� PERMIT APPLICATION SIGN OFF TRANSIV�ITTAL SHEET
To be completed by Applicant.•
Building Site Location:��� ��� a� ,� ��-• t;() . U q���o a � 1� ,'Yl ,�}-�'�Z(n`'t t 0
Proposed Improvement: �X�S�'�1 n C� (,►S.��3�,-.G� .t� '����
Applicant: ��.�G s�- �q�1 Gi k7 Q f� Tel. No.: ��y � a� �a 3�
Address: ��� ��, �„� ��3 �°��v,,�,n Q i A; �� v1�1�q.. p a � `� Date Filed:
**Ifyou would like e-mail notification ofsign off,please provide e-mail address:
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Owner Name: �� ' �/'� � p � { �
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Owner Address:'��? (��},rti,,�yz; �`„� 4 1�(n ,�}L) R_. ���;Ltr�l) Owner Tel. No.:�t`7_�Cr�'7,T��3
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RESIDENTIAL ANp/OR COMMERCIAL BUILDING
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:
(1.) Site Plan showing existing buildings, water line location, ;
and septic system location; -
(2.) Floor plan labeling ALL rooms within building �
I (all existing and proposed) — �
� Note:Floor plans not required for decks,sheds, windows, roofing; '
: (3.) If necessary, Title S application signed by licensed installer i
with fee. �
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REVIEWED BY: ��� � DATE: � � � E � I �.
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PLEASE NOTE �
COMMENTS/CONDITIONS: �
M�ST .-��yo /�,2 r��. k� �-�� �
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