HomeMy WebLinkAbout2008 Mar 21 - Sign Off Transmittal Sheet - Alter Wall �:.�.� _._., � :_,�
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,�°��Y`9'4�. TOWN OF YARMOUTH
� y HEALTH DEPARTMENT
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a" pERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Appdicant:
Building Site Location: �.Ta -t'" Map No.: Lot No.: �
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�� � Proposed Improvement: /-� � � ��,Z., � 1-� '� �� ��' ,z.` S �
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APPlica.nt: ��.�,1.�NA�1 ����.. j�'�`'��� .`3 Tel. No.: _`��?� Z7� ��)� �
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Address: �(� ` _`�'i ����'T �t2)l�.�r�i�f�'T'�",2 �J�1 F� C�L:�"'� Date Fi1ed:
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**If you would like e-mail notification of sign off,please provide e-mail address: �
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' Owner Name: \,W i21`�``!f 5 b �` t A i�� c� 3�
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Owner Address: �(� j�L��}Sk�IT _`�,-T' }-1�//�(V N 1 S Owner TeL No :�""o� 7�/c�yc� !
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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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E : Please submit four{4) copies of plans, to include:
f (1.) Site Plan showing ezisting buildings, water line location, '
F:: and septic system location; '
,F2.) Floor plan labeling ALL rooms within building '}F7� "
(all ezisting and proposed)— ��`�'
Note:Floor plans not required for decks, sh,�ds,.K!��lo�s, roofing;
(3.) If necessary, Title 5 application�� � ed � nsed installer
with fee. ' .'� ' `�
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REVIEWED BY: DATE: c�1 V �
PLE�ISE NOTE
COIVIlVIENTSiCONDITIONS: . / y�,
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