HomeMy WebLinkAbout2018 Feb 07 - Sign Off Transmittal, Plans, Assessors Info - Finished Basement`3
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To e completed by Applicant:
Building Site Location:
Proposed Improvement:_
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TOWN OF YARMOUTH
HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
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Applicant: A J � � 6 .1_��� �'` � Tel. No.: -7ZDZ � I
Address: � �. U)a10 2Vf^ �� c. rt G-3 Ic� Date Filed: ?z
**Ifyou would like e-mail notification of sign off, please provide e-mail address:
Owner Name: (V A -&IJ
Owner Address: R) Mo
HEALTH DEPARTMENT:
Owner Tel. No.:
Dete Ines Co lance to State and Town Regulations; i.e., Requirements
FojSeptage QXposal and other Public Health Activities.
Please mit three (3) copies of plans, to include:
(1/(all
)51 Plan showing existing buildings, water line location,
and septic system location;
Floor plan labeling ALL rooms within building
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.
REVIEWED BY/ DATE:
PLEASE NOTE
COMMENTS/CONDITI NS:
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