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HomeMy WebLinkAbout2006 Dec 21 - Sign Off Transmittal, Plan Sections - Cellar Bulkhead ; :.: , , ...-� , , .,...s , . ...f, .f� _ �::. ...,. : u«'"�`x`-�"-a`. .v",. .'�:'� `�`.'s. ' ;. ..':i%� -��...' . , � : . .� .. J • . .- _ . I � . ,�.� �� ... �•,T � . : � ,�°��Y`�'��.o � TOWN OF YARMOUTH � o y HEALTH DEPARTMENT �"""��'�� ° �' PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: ' Building Site Location: �� ��i�,� r.1U�(' 1, '��� � ��y�� Map No.: � �� ��Lot No.: t- ; Proposed Improvement:��l�ll� l�j 1/1;`k �e� i �-+ /� ; Applicant:__�C�'�(� C� �� ` � Tel. No.: ; Address: ��� 1 y `t'✓t� �� ��i�h� 0`�' 1�+`�' ' Date Filed: **Ijyou would like e-mail not�cation of sign ofJ;please provide e-mail address: �I���CO�GO{�S��C.�1�CU ���� � � Owner Name: J�h{� + �(,�N �Q�C.�� ; Owner Address: � � l-���`� r Ir���I � Owner�'el�.�Vv �D�� '�' � I -----..._............................................�---�-�---...._........_._.:.._..--��------------------------------�----------------------�-�-----------�- ' � i -----................._................---------.._..-------------------------------------�--.........---------------.........--------._.._.......---.........___.... - I � RESIDENTIAL ANDfOR COMNIERCIAL BUILDING ' _ � HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements For Septage Disposal and other Public Health Activities. , Please submit four(4) copies of plans, to include: ! � (1.) Site Plan showing ezisting buildings, water line location, j and septic system location; (2.) Floor plan labeling ALL rooms within building (all ezisting and proposed)— �Vote:F[oor plarts not required for decks, sheds, windaws, roofing; ! (3.) If necessary, Title 5 application signed by licensed installer � with fee. ----------��--�----------------------�-----��--�-------�----�---�--�---��- -----------�--�--................_..........- ��--- �-��---�-�-�-��-----------------�------�------------......................................-��--��-----._.......-------------........---................-------------�-----��--�---------._......--�--------------.... REVIEWED BY: f DATE: /�— ��—d � ; PLEASE NOTE � COMI�� S/COND IONS: � � �y ; ; ; ,.. � _ � , iu ' � �. . ; � � . � � �i� � C� I� � CDMC� [� J A� 1 5 2002 . . H�A�.TN �3�€'�`. . 113.3T 560d 55'45"W Map 91 Lot 165/ Map 81 Parcet N050 �/ � / N Z footprint=2.34�4 5A• F'� b . 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