HomeMy WebLinkAbout2016 Sep 25 - Sign Off Transmittal Sheet �_,�,..
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.o� Y'�k TOWN OF YARMOUTH
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�; � ;�'-;� HEALTH DEPARTMENT
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��=E PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant.•
Building Site Location: -�.? � � ��� �..,��GG;�'"� �i►'�
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Propose Improve ent: _ ,�+'�/,�'�` �- �/ �7`7' �'�1 �� �s�'G--
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Applicant: !�/ c�"'i/ �..---�- Tel. o.:...�8"G�++ �.•8'�
Address:<:� �' �L?/� • r Date Filed: �
**Ifyou would like e-mail notafication ofsign off,please provide e-mail address:
Owner Name: f�C�.;�� /��f ��i�-�',�'�
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Owner Address: `�jl'��' ,�",� ,/e��`� Owner Te1. No.:� �` � `�/`�
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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:
(l.) Site Plan showing existing buildings, water line location, �
and se tic s stem 1
ocation•
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� (2.) Floor plan labeling ALL rooms within building
� (all existing and proposed) —
Note:Floor plans not required for decks,sheds, windows, roofing; �:y,
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
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REVIEWED BY: DATE.d a SA ��
PLEASE NOTE
COMMENTS/CONDITIONS: j
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