HomeMy WebLinkAbout2017 Mar 16 - Sign Off Transmittal - Use and Occupancy - SAAS Company oti Yak TOWN OF YARMOUTH
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����'`� `'Q���� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
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To be completed by Applicant:
Building Site Location: �-5� (,0 �110� � �0.�YY16�'(1�CoC'C` /��� pZ(Q`� �j
Proposed Improvement: /�� "' �Se �t� �C�'{t�nC�
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Applicant: ��,F� �d�}1�-��'D�-S TeL No.: 5o�-(c�$I'Z(�L��7
Address: Date Filed:
**Ifyou would like e-mail notiftcation ofsign off,please provide e-mail address:
Owner Name: S�'1he5 �To�d�511�i�h
Owner Address: 7S�U /V ��/�11TiC �! q65 Co(„��}bQu�h �L Owner Tel. No.: �Z(-�1y�-�Z(�d
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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. .
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, roofng;
(3.) If necessary, Title 5 application signed by licensed installer
with fee. '
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REVIEWED BY: DATE: ^ /� r
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PLEASE NOTE
COMME TS/CONDITIONS:
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