HomeMy WebLinkAbout2017 Jan 03 - Sign Off Transmittal Sheet, Floor Plan - Addition,�.«. . _.a.�.�� �� ._ .���-.,.�-�.�.���. �-_ _
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�o��-a,��,�o TOWN OF YARMOUTH I
�� �- �- ,� HEALTH DEPARTMENT ;
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��''� `�`�r� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET '
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To be complefed by Applicant.• '
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Building Site Location: � �. /�� � ��� �� �� � �
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Proposed Improvement: ��/ C7 �U �� � � !.�' ;
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A licant: � l � N T�l.N� (7�g� Q�� � '.
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' Address: L•� �/ r a Date Filed: a ��'� �
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**Ifyou would like e-mail notification ofsign off,'please provide e-mail address: ',
Owner Name: /r_( /�.� :2 �• '
QU�f� � 7 i
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2 r � � '(�'`t�/� Y �, � Owner Tel. No.: � ;
Owner Address: ,
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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 i
(all existing and proposed) — !
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Note:Floor plans not required for decks,sheds, windows, roofing; j
(3.) If necessary, Title 5 application signed by licensed installer !
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with fee.
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REVIEWED BY: DATE: �?► " .�?'J/ i
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