HomeMy WebLinkAbout2016 Jun 30 - Sign Off Transmittal Sheet - Use & Occupancy ...,,�.�..,.�.�_� -.�. � __
,.o�'-'Ya� TOWN OF YARMOUTH
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�t �-°';c HEALTH DEPARTMENT
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��"''--=�=E-`���� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant.•
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Building Site Location: � — � � �� � � �"{' �
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Proposed Improvement: 1{� _.. V --• ( Z a. �U'�N
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Applicant:��-l���.J—��1 ��,.� Tel. No.:� � '"'2 Z.,
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Address: � � Date Filed: (rj
**Ifyou would like e-mail notafication ofsign of�'please provide e-mail address:
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Owner Name: (.�,�[� '"�` ���N�.�q �QF-1'��1�i I
Owner Address:�p _�X� '� . .�'J� 7�'Z-� 2. ''
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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:
(1.) Site Plan showing existing buildings, water line location,
and septic system location;
(2.) Floor plan labeling ALL rooms witnin 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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REVIEWED BY: DATE: � �G �C�
PLEASE NOTE' c
COMMENTS/CONDIT�QNS: c��� � v � *
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