HomeMy WebLinkAbout2013 Mar 01 - Sign Off Transmittal Sheet, Plans - Garage Addition ,._�._..� �.� �-- -�--�r
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a���,� TOWN OF YARMOUTH
��' �.-`�� HEALTH DEPARTMENT
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�'�"+t�ACNEj'�' pERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: y C�+`c.k t't.l L n� .
Proposed Improvement: G A�a U� A�I ct�f-`o�v
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Applicant: n'1 a f�H e w L . Ct�,' (�! Tel.No.: �v1� -7 9 0-�Zt-1 Z
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Address: � D r��.;� �-�v• Date Filed: Z�2$ � t 3
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**If you would like e-mail notification of sign o,f);please prouide e-maid address: (3+�p c.t 1� 1 � C orvtGq S f � �e f �
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I Owner Name: /►�1 f f h�w C.. Gk�'l c.�S i
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�4 Qwner Address: � Or�.1�,'� �.N. Owner Tel.No.: ��3-7 5 d- 3 Z'-I Z ;
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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.
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Please submit three (3) copies of plans, �o include: ''
(1.) Site Plan showing ezist�ng buildings,water line location,
and septic systvm location; '
(2.) �'loor plan labeling ALL roorns within building
(all egisting and proposed)-
l�ote:Floor plans not required for decks,sheds, wandows, roofing;
(3.) If necessary, Title 5 application signed by l�censed installer
with fee.
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REVIEWED BY: DATE: � -- /'` /�
PLEASE NOTE
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