HomeMy WebLinkAbout2013 May 13 - Sign Off Transmittal Sheet, Floor Plan - Storage Area. �._ _ � � � „�. -�f , -��. � . � . .
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; oti Yq� TOWN OF YARMOUTH
'; o� ���y HEALTH DEPARTMENT
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� ''��E` PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
'j �� To be completed by Applicant: C►j�,� Gv � �$
�� Building Site Location: �� �/! (�� �D G�C �U '
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�, Proposed Improvement: �i rn In� 5� S ���'J � ��� � r� � �����'���'�U� QT�`r�P
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'' APPlicant:i�ti�///lf r� �U/�! C h �fi,P r� Tel.No.: � 3 G 2 - �371��
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Address: 1� �P ty � Date Filed: �`'l �'- � 3
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II; **Ifyou would like e-maid notification ofsign off,pleaseprovide e-mail address:
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Owner Name:��/!��� �rtl �U�l P�)�Z-C'[r'i
Owner Address: 7� � l�r r�c° �C/l �C� r Owner Tel.No.:3���G?3 7��
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RESIDENTIAL AND/QR COIVIMERCIAL BUII.DING
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulahons; 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 la.beling ALL rooms within building
(all existing and praposed) -
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: �� ��— � �
PLEASE NOTE
; COMMENTS/CONDITIONS:
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