HomeMy WebLinkAbout2019 Jan 07 - Sign Off Transmittalov- YA k
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To be completed by Applicant:
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Building Site Location:
Proposed Improvement:
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Applicant:aC
Address: <ff
TOWN OF YARMOUTH
HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
**Ifyou would like e-mail notification ofsign off, please provide e-mail address:
Owner Name:
Owner Address:
Tel. No.: Q �J j % ' t
Date Filed:
Owner Tel. 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:
(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: