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2016 Jun 23 - Sign Off Transmittal Sheet, Floor Plans, Site Plan - Use & Occupancy
oti Yq� TOWN OF YARMOUTH , �..�� �� � ;1�-° HEALTH DEPARTMENT o:..a;.,�_ _ .:.r�-3 �'�+r`'��.�.-"���1'� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: � Building Site Location: a� �,�.rs Q,(�_���„�,�� Proposed Improvement: :,Z Q St"'� �— � � ✓ �- * Applicant��� C�� TeL No.: �l� c�3�j �(oI 7 Address:��.,. �C2 . ��,2mcu{� Date Filed: / **If you would like e-mail notiftcation of sign off,please provide e-maid address: i - Owner Name: ��'�� �F.�L\E,\���1Uh1�0EC � . �- Owner Address: �.��2 UJH\�"E-�� QF1�► S�la�'hZUISC� Owner Tel. No.: � �(y- �2„� � ..:......................:..............................:...............:...................................�................:.........................................................................................................................................................:..........��.............................. r � RESIDENTIAL AND/OR COMMERCIAL BUILDING � HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements i ; For Septage Disposal and other Public Health Activities. � � �'�learse submit three (3) copies of plans, to include: � (1.) Site Plan showing existing build;ings, 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. � ...............................................................:...........................................:.::::......................................................................................................... � � ............................................................................................................................................. REVIEWED BY: DATE: � , 9 I PLEASE NOTE � COMMENTS/CONDITIONS: � �� �C�t.� ` .� y /` �',���g,Kt��S�''.�Zl�/I � P. , � � _ 1 ( . 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AN i ,'J71VA-E,4Li�f i t{ �- HEALTH DEPT. 07 un , f PURPuSE: SE-PTIC REPAIR LOCUS: SAS 11020 0519 Stan Ave. South Yarnvuth, MA 02664 PREPARED FOR: Union Station Condominium Assoc. 23-B2 Whites Path South Yarmouth, MA 02664 DRAWING TITLE: Existing Site Plan CAD TECH: DESIGNED BY: V.A.L. G. K. ENGINEER: CHECKED BY.- G.D.J. T.F.B. DRAWNG SCALE: e, 0f DATE: SHEET: �''