HomeMy WebLinkAbout2016 Sep 06 - Sign Off Transmittal Sheet ,w-=.,..�.��.,�-.�--.�--. .�, _� . � �.s,..
o��k.� TOWN OF YARMOUTH
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��~''�-�E���� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: � /% �� � l ��
Proposed Improvement: Q��'r��v� ��p(�� ���' , ./��� �Cjp�
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Applicant: � C h t o'� �C�%�i(CX � r• Tel. No.: ��� �S�� l�7(fl�
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Address: �`�.. 63vG[�C��e� ��� �v�!l'tH 1 S t�c �+ Date Filed: �` � ^�d(�
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**Ifyou would like e-mail notification ofsign off,please provide e-mail address:
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Owner Name: �G O�P��jl�/ �C Q U/ ��' -
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Owner Acidress: �`� �C? �T4 f{ CA�' Owner Tel. No.: �7�'�j• �3� ���
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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,
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: ,C�'c.lZ/ DATE: '' � "`�
PLEASE NOTE
COMMENTS/CONDITIO S: /� / �/
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Yarmouth Health Department
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