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HomeMy WebLinkAbout2016 Jun 15 - Sign Off Transmittal Sheet, Plan - Deck Extension ..��_ �� ,,.,,-.��-n.. �--- � �.,�-�-,�-�.-.��. : , . , :-� _._ �o�.�'-�a�r TOWN OF YA�M�UTH ��� �, ;�--� HEALTH DEPARTMENT °�::� .�- �;,� �`'� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET . •r r,,,��c,tr'J . To be completed by Applicant: Building Site Location: ff i s �n� ,.,. o no,�� r� Proposed Improvement: (, � �Y;,•,v%o.c� � -F C x, s�.•✓� �r�{� �i 7=G�x i t � G�� A.v� ,f1�i►c h Tr� ,�. .��- ��K A S ��,'t. �� A eJ Applicant: /i c�-IA�� � G.¢h 1J�itr./ ..� ;Z Tel. No.: >�• �3�- �63v2 Address: �,s/ /,l/od�S� D�. ila.� �� . ��A�? S i A�c3�F', 1 '/� Date Filed: /5 /� **Ifyou would ldke e-mail notification ofsign off,please provide e-maid address:_�?��/t�,n?,vr�,q�/� � /'y,,�/, �"o,•-, � Owner Name: J., ��.. ��e �'z,u �- �f,N�qs w,,� Owner Address: �H!� A%�� J�A�, y�t;�'wro��r �7► �j��Owner Tel.No.;, 1•6 3 �y S 1`� .:.................................................................................................................................:..............:.............................................................................:..............:..............................................:................................................................... 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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