HomeMy WebLinkAbout2016 Sep 16 - Sign Off Transmittal Sheet, Plans - Enlarge Bathroom , y_ _
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.o!�-"''a� TOWN OF YARMOUTH
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�i `�'-'c HEALTH DEPARTMENT
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���'' `���� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
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To be completed by Applicant:
Building Site Location: � 11-` �--�' �(� `������-�p`--�-�-
Proposed Improvement: _ ���,��.ti C X��,..��P`�'� ��'���(��7
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A licant: � ���
Address: \(`�T��G�C� ��"�. ,�� t=5�1.��,_,��� Date Filed: ! �� � � '�,
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**Ifyou would like e-mail notification ofsign off,pleaseprovide e-mail address: ��rc1.i..�Y � �[C�"j(t, �p� �
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Owner Name:_�Q� r» ��� �t.l,l�
Owner Address: '��-,�t,� ��_ �� �,�p,�--�; Owner Te1.No.:
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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:
(1.) Site Plan showing existing buildings, water line location,
and septic system location;
(2.) Floor plan labeling ALL rooms within building
� (all existing a�d proposed) —
Note:Floor plans not required for decks,sheds, windows, roofing;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
REVIEWED BY: DATE: �Fo �
PLEASE NOTE
COMMENTS/CONDITIONS:
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