HomeMy WebLinkAbout2017 Aug 07 - Sign Off Transmittal - Guest House/1 BR Garage Studio -�-�-�-- �.���- �, ,_ = :
�oti ��,ya TOWN OF YARMOUTH _
y�; t�.fv�� HEALTH DEPARTMENT
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�'�``';+ `'��$ PERIVIIT APPLICATION SIGN OFF TRANSMITTAL SHEET
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7'o be completed by Applicant:
Building Site Location:�` /%� 1��v�c.r S��r�
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Proposed Improvement: F v t �- a-� � �� `���
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Applicant: S�^t V+� �- Cc�C.. Tel.No.: 77�/-3/3-(//G 3
Address: v r u-, 1�t+ G r �� %/�s Date Filed: �
**If you woudd like e-mail notification af sign off,'please provide e-mail address:
Owner Name: �e f C�,.�'2 ��S
Owner Address: (�.(��¢ �L.�vY S-�-r�c-r�` �/�'�w�a�, Owner Tel.No.: (/7-� �S-���
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RESIDENTIAL AND/OR COMMERCIAL BUILDING
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e.,Requirements
For SeptageDisposal and other Public Health Activities.
Please submit three (3) copies of plans, to include:
(1.) Site Plan showing existing buildings,water lirie 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. I
............................................................................................................................................................................................................................................................................................................................................................. .
REVIEWED BY: DATE: � �
PLEASE NOTE
COMMENTS/CONDITIONS:
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