HomeMy WebLinkAbout2017 Sep 19 - Sign Off Transmittal - Pool �_ -_ __� �_T
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o!�-'Y'�� TOWN OF YARMOUTH
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�-��=�- PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
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i To be completed by Applicant.•
Building Site Location: �� �
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Proposed Improvement: —"�'lJ r�v�'�GC .S!,J+ �'�'i v-�r�N (/Z)( `�' ��� l f-G"X('�( ,
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Applicant: �:��t�e .[:.7 �--�G�n c��. �/�,-f�f ..�/�C Tel. No.:S'C�:��.f��4���
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Address: ,3 1�Y1� �J � Gti 7` � �, `�r������� Date Filed: � /��
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**If you would like e-mail notafacation of sign off,please provide e-mail address: y,��U1s C���/�`�(ti ��vy+�t CC[�SZ', /(%7°�
Owner Name: G��� �Gi(6n d�
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Owner Address: '�a2 � ��-'��. ���� �LJ Owner Tel. No.: %���-��- 3/-��
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RESIDENTIAL AND/OR COMMERCIAL BUILDING
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
(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.
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REVIEWED BY: DATE: �'
PLEASE NOTE
COMMENTS/CONDITIONS: