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2015 Oct 20 - Sign Off Transmittal Sheet, Floor Plan - Storage/Laundry Area
�o�'�,'r,-q�e,� , TOWN OF YARMOUTH a µ °° HEALTH DEPARTMENT s ��� s �'�'`���M6``� � � PERMIT APPLICATION SIGN OFF TRANSMITTAL S�IEET To be completed by Applicant: Building Site Location:� � .� � Proposed Improvement: t ' . Applicant: �„e��,,,�x,..��"`,a,;,�►.,,...e Tel.No.: '7'7+y �r4�' �io�'7 Address: (�f� .�,,�,.�.� � (� '�.� O a� r� Date Filed: Id J ! � � E'G���-�� �c' d, � � **Ifyou would like e-maid notification ofsign ofJ;pdease provide e-mail address: '��t.�� �V��_C��S��N��Q/{� Owner Name: ` . i�tie�.�.�tt�. qwner Address; ► ���,� . �.�,�.te���Owner Tel.No.: �d'� 3�.,;,Z�TLC,t= ...........:�........................................................................................................................................................................................................................................................................................................:.......................................... t RESIDENTIAL AND/OR COM1ViERCIAL BUILDING HEALTH DEPARTMENT: Determines Compliance to State and Town Regularions; 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 within building (all ezisting and proposed) — Note:Floor plans not required for decks,sheds, windows, roofing; , . (3.) If necessary, Title 5 application signed by licensed instal�er with fee. .............................................................................................. ....................:.........................................................................................................................................................................:...................................................................... . __ REVIEWED BY: DATE: l G �4_�/ ,I S PLEASE NOTE COMMENTS/CONDITIONS: ' � , 1 �r�--7- ��� - ,�� �� ���.-�� J O ,"�o'r J ...- /J S � � 1 y" $ 'y � �.c ; �_ . __...�v. _ _.. _ .--...__ ..._ ....__ _..._ . _- _..... __ _ . _ _ _ . ,"3 0 0� _� � m -... . 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