HomeMy WebLinkAbout2009 Nov 18 - Sign Off Transmittal, Plans - Addition, Laundry . .+�e�*�-r-.:<-sT�n.�^wsngfi•-.x--�•^�r n-�: . ----�.�-.,—,..-.. . _
�.°��Y`9'4�o TO'�VN OF YARMUUTH
� y HEALTH I�EPARTMENT
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'"'°"a � PEItMIT APPLICA'1'ION SIGN OFF TRANSMITTAL SHEET
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To be completed by Applicant:
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Building Site Location: ' ��� �)�'L s I Map No.: t Lot No.:�
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Proposed Improvement: / , � t� �-r'1' .
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Applicant: � l�.'�i't� C�� � � Tel. No.: �6& . �)/ �l Z�
Address: "1 � � �� /� t tm t � � Date Filed: //–'r�i"-�''fj
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**Ifyou would like e-mail notification ofsign o,fj;please provide e-mail address: '
Owner Name: ���-n w � t��vL'�'
Owner Address: �/��- �U�- S � Owner Tel. No.:
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RESIDENTIAI.AND/OR CO1ViMERCIAL 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,
and septic system location;
(2.) Floor plan labeling ALL rooms within building
(all ezisting and proposed)-
Note:Floor plans not required for decks, sheds, windows, roofi�eg;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
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REVIEWED BY: DATE: � j I�1���
PLEASE NOTE
COMII�NTS/CONDITION :
1
A.3
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