HomeMy WebLinkAbout2016 Sep 22 - Sign Off Transmittal Sheet, Plans - Kitchen Extension�
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� ,� ,,� TOWN OF YARMOUTH
� ��-`-�;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: �{ �.i�T 1 e t I t �pe(' i�h� , s� ��/�vj��,
Proposed Improvement: �j t
Applicant• l ' Te1.No.: ��-'�p 3 D—�n�
� Address: o� ` 0 (' Date Filed:���
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**If you would like e-mail notificatfon of sign ofJ,please provide e-mai!address:
Owner Name: �
, Owner Address: c�`t I..t �,�,r ����.�VQ(I�IUl�wner Tel. No.: S(�f/?'1�'.
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RESIDENTIAL AATD/OR COMMERCIAL BUILDING
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� HEALTH DEPARTMENT: Determines Compliance to State and Tawn Regulations; i.e.,Requireme�ts
' For Septage Disposal and other Public Health Activities.
Please submit three (3) copies of plans, to includes
(l.). Site Plan showing ezisting buildi•ngs,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 installer
with fee.
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REVIEWED BY: DATE: `� a .(,,�.
PLEASE NOTE
COMMENTS/CONDITIONS:
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i Existing Kitchen To Be � � ;
i . Extended Out To i R '
� Existing Shaded Area
i Bedroom _---`� _ r-- ---—-__ _ �
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' � � RECEIVED
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! - S�P � � 2�16
; Existing
Living Room
, HEALTH DEPT.
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' �� 24 Littie Dipper
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Litde Dipper Lane - .�