HomeMy WebLinkAbout2007 Oct 10 - Sign Off TransmittalYAK TOWN OF YARMOUTH
HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
be completed by Applicant:
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Building Site Location: H Cc; Map No.: Lot No.:
Proposed Improvement: C: i (7 (7 ij y
Applicant: {� ,.
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Address: `2 'f =,
E'' � �"" � � v�� ::��t � ` Date Filed:
**lfyou would like e-mail notification of sign off, please provide e-mail address:
Owner Name:
Owner Address:
Owner Tel. No.:
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 four (4) copies of plans, to include:
(L) 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.
REVIEWED BY: DATE: ` o C
PLEASE NOTE
COMMENTS/CONDITIONS: