HomeMy WebLinkAbout2017 Mar 30 - Sign Off Transmittal Sheet - Move Deck Post . �_. :.�.� _ ��.,�_,��,� ...�..�.�-R� . :�,.._ _Tn� ._ _ �.�. ��.�-_�,,,,�.�,�.,-.�.�
o�,�`�k� TOWN OF YARMOUTH
�f � ;%�- ;° HEALTH DEPARTMENT
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��~'' ``�j$ PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
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To be completed by Applicant:
Building Site Location: oZ � � ��v c �c��l� I� �
Proposed Improvement: /�'1 a'tJ-� GI'��-/� ��a ST f!/`i" p �,�
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Applicant: � bs�� � �� ���-,. d�� Tel. No.:saF -3��^y8�
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Address:_��j' C����� �lZ � �r'y-t..--- Date Filed: �3d / ?
**Ifyou would like e-maid notification ofsign off,please provide e-mail address:
OwnerName: �1�� -� �Arv��' ��c �I,, fi�
Owner Address: Owner Tel. No.:
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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.
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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: � G/� ����� • - p r/�
DATE. �j ,S
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PLEASE NOTE
COMMENTS1CONl�ITION : ,
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