HomeMy WebLinkAbout2016 Oct 21 - Sign Off Transmittal Sheet - Demo Exisitng House, Garage �� Yqk TOWN OF YARMOUTH
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HEALTH DEPARTMENT
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�=`r PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant: 1 �` � �
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Building Site Location: /� � r��.��„m� �,,`
Proposed Improvement: c� � '� �J a�,� _ �'w s r ��
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Applicant: ���e 1.... L,.�,w`1',jro S Tel. No.: 5�0� �6'����
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Address: � ��-,,� �� ��,,���1�,�� (�V�,,S�, Date Filed: /o a,! i,G
**If you would like e-mail notification of sign off,please provide e-mail address: S W►4 � (� � C�,�,,, s�.� N,c�-
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Owner Name: �a-,ti�� �E �05� �o.v 1Srn. �
Owner Address: `�oZG �ca�rt W v� ��s-� ��'��S ��. 9't,�0y Owner Tel. No.: b��'� 5�'b Y��
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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 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: lG � � ��
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PLEASE NOTE
COMMENTS/CONDITIONS: