HomeMy WebLinkAbout2016 May 26 - Sign Off Transmittal Sheet - Use & Occupancy ;,a.�.�- �-v ,� �� . ,.. _ . ..�_�. _ -.�3 . _ _
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��� _.o..�,��,� TOWN OF YARMOUTH
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'��''� ``��� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
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T be completed by Applicant:
� Building Site Location: � �,� " ; r✓ : �6�1� � �
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Proposed Improvement:�,/�+� �' �!�� � v��1 NC�/ - �v,�1� ��w ��} � �-
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Applicant: �r r",��/-�r � ( �r�✓� /� ��` /�,�✓ � � t Tel. No.: ���'� �r'�SZ�
Address: � �K n;f=p f �� C��W i G� ��. �l 2-6L�� Date Filed: � 7
**If you would/ike e-mail notification of sign off,please provide e-mail address:
Owner Name: d� �;�q�.��i�� ���/'(
Owner Address: � t�, ,���� �(�G' � . ��,�'�� ���Ci f Owner Tel. No.:,,��- 7�/'` �Q
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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:
(l.) Site Plan showing existing buildings, water line location,
v and septic system location;
(2.) Floor plan labeling ALL rooms within building ;
(all existing and proposed) — i
Note:Floor plans not required for decks,sheds, windows, roofing; i
(3.) If necessary, Title 5 application signed by licensed installer ;
with fee. j
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REVIEWED BY: DATE: � t�� C� �'
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PLEASE NOTE i
COMMENTS/CONDITIONS:
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