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disi Application for a Permit t Build No.
V Fee must accompany thi plication
Yarmouth ..?PC
4 19R-0TO THE BOARD OF SELECTMEN
The undersigned hereby applies for a permit to build, according to the following specifications: ,
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1. Name of Owner _ Address -'4/' t &eaten_
2. Name of Architect (if any) •• . ,
3. Name of guilder
4. Precinct No. Lot No. G Plan: Name or No. A.M. 34-5(0
5. Name of Street t, t e r• Yve ns aur4
6. Purpose of Building _
wood urrcifr 2'i' '
7. Material tgexf9/ '
8. Estimated cost of building '•
9. Dwelling /02 rrl)-Q
10. Cottage d0
11. Heat i
12. Basement { • ,
13. Garage
14. Store
15. Shop '
16. No. of stories . r
17. Is there to be a Store inthe lower storey
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18. Size of Lot. No.�of feet irony ' No. of feet mar /r' No, of feet deep
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19. Size of building. No. of feet front No. of feet side '''I No. of feet rear Cr
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20. Distance from nearest building: Front ft.; side ft.; side ft.; rear....:...
21. Distance back from line or street from rear lot line '°' r '• , side line r^ .41a r
Show by diagram the location of propsed building with relation to distances from adjoining lots, on reverse side.
Name
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Address
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Rear of Lot
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Frontage of Lot ° `
.sti? Street Name .
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` *1/4.• PLOT PLAN t +
IsBUILDING PERMIT REVIEW
APPLICANT: / BLDG PERMIT NO:
WCATJ N OF PROPERTY: - • DATE FILED: •7 - 6 - p-e,
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THE FOLLOWING CHECK-OFF SHEEP IS DESIGNED TO CLARIFY THE PROCEDURES AN INDIVIDUAL MUST
FOLLOW IN ORDER TO OBTAIN A PERMIT TO BUILD OR ALTER A BUILDING. THE BUILDING DEPARTMENT
WILL CHECK ON THE FOLLOWING: (A) CONSERVANCY DISTRICTS (B) HISTORICAL DISTRICTS (C) FLOOD
PLAINS ZONING, AND WILL BE RESPONSIBLE FOR ASSISTING:THE APPLICANT THROUGH THE FOLLOWING
AGENCIES.
WESIDENTIAL BUILDING:
4) CHECK WITH THE HEALTH DEPARTMENT IN REFERENCE TO SEPTIC SYSTEMS FOR SEWAGE DISPOSAL.
9) CHECK WITH CONSERVATION COMMITTEE IF THE LOT BORDERS ON ANY TYPE OF WETLANDS.
EXAMPLES: STREAMS, PONDS, RIVERS, OCEAN, BAY, BOGS, MARSH, ETC.
) CHECK WITH PLANNING BOARD FOR LOT RELEASE.
MUIERCIAL BUILDING:
) ENGINEERING DEPARTMENT-FOR PARKING AND DRAINAGE REQUIREMENTS, TOPOGRAPHY SITE PLAN
REVIEW.
) CONSERVATION C&MITTEE-IF LOT BORDERS ANY TMPD OF WETLANDS.
;) PLANNING BOARD- TO SEE IF LOT COMPLIES WITH ZONING BY-LAPS.
) BOARD OF HEALTH-FOR SEWAGE DISPOSAL REQUIREMENTS, HEALTH RELATED ACTIVITIES.
EXAMPLES: SAUNA BATHS, SWIMMING FOOLS, RESTAURANTS, ETC.
) FIRE DEPARTMENT-FOR PROPERTY PROTECTION, PERSONAL SAFETY, (SPRINKLERS, SMOKE
DETECTORS).
•
7VIEWFD BY: /
G�/INNEEERING DEPARTMENT: YES /DOES NOT APPLY_SIGNATURE +cam ibgNecb, DATE 814/86
!NSERVATION COMMITTEE: YES✓ DOrS_NOT."APPLY_SIGNATURE CAC oe,,ipt DATE 0/(t5
JOF
G BOARD: YES DOES NOT APPLY SIGNATURE/.
/ -DATE
HEALTH: YES✓DOES NOT APPLY SIGNATURE b. � �!�/ DATE Vyge
IRE DEPARTMENT: YES DOES NOT APPLY SIGNATURE DATE
OMMENTS:
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