HomeMy WebLinkAbout2008 Mar 03 - Sign Off Transmittal Sheet - Finished Basement: . .. : ,- ���� . ���,�;.�
,�°� Y��o ' TOWN OF YARMOUTH
o _ y � HEALTH DEPARTMENT
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� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
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To be completed hy Appli.�ant:
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Building Site Location: �� CL./�/7�9z-�c.. Map No.: Lot No.: ��
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Proposed Improvement:� �Z�� ���/J�-,-►�i�r ,�%�z-�'T" �r�ZZ-�--' �
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APPlicant: �/`'T C�.- Y l-�'S `���,� /-�,r'�/l�c� . Tel. No,.�f.k�-�-'d�-��-�-�--� ;
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Address: �.S� C� G f',Ga��G�j,�,,��2�'°�--�..�,,f�-a,� ' Date Filed: --����d d�`
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**If you would like e-mail notifrcation of sign off,please provide e-mail address: {
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Owner Name: l�-- � �"`�~��� �
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Ow�er Address`� � Owner Tel. No.:� Qy�7- 90/ . !
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RESIDENTIAL AND/OR COMIVIERC�AL BUILDING
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements
For Septage Disposal and other Public Health Activities. ;
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Please submit four (4) cop�es of plans, to include: �
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(1.) Site Plan showing ezisting buildings, water line location, �
and septic system location;
(2.) Floor plan labeling ALL rooms within building
(all ezisting and proposed)—
Nnte: Floor plans not required for decks, sheds, windows, roofing; ,
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(3.) If necessary, Title 5 application signed by licensed installer
with f�e.
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REVIEWED BY: DATE: �
PLEASE NOTE
COM1t�NTS/CONDTTIONS:
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