HomeMy WebLinkAbout2016 Aug 23 - Sign Off Transmittal Sheet - Temp. Refrigeration Storage Container ��f ��a TOWN OF YARMOUTH �.. Qv�T J�
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��- PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: -b �� "-� �� "� ' 7���QC��j� �� ���7�'
Pro osed Im rovement: i'' n�-� �/✓l�c� t,��J S��v2l� ��
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Applicant: �l��o� ��9�W2 Tel. No.: � S`72 7�'j 2�
Address:�� ��flcfl �,e�/i,�,� S� ,�y�/�r�ir'� �tGI 0.�6ly Date Filed: �� /
**If you would dike e-maid notafication of sign off,please provide e-mail address: ,
Owner Name: ��+��/I �c� �/YI/7,cJ,(,/a�� . ;
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Owner Address:C� t �j���'d1�t,��21��Owner Tel. No.:
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RESIDENTIAL AND/OR COMMERCIAL BUILDING
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� HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements
' For Septage Disposal and other Public Health Activities.
Please submit tbree (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 egisting 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: �' �3 / �
PLEASE NOTE
COMMENTS/CONDITIONS: