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HomeMy WebLinkAbout2009 Aug 27 - Sign Off Transmittal, Floor PlanY . ° . '� 0 TOWN OF YARMOUTH - _ y HEALTH DEPARTMENT G MAT TA M ESE PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: Building Site Location: r A Map No.: Lot No.: Proposed Improvement:' - 1't P�� `/OG_%] ��t /� Applicant: /` 2i A' /3 Address: **Ifyou wou d like e-mail no �ati n of sign off, please provide e-mail address: Owner Name:, r,, '; S r-, -�- Dwner Address: �� % Owner Tel. No. - 0 7 % - 9/0 .................:................ '...�`.. -- .=.. 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: r PLEASE NOTE COMMENTS/CONDITIONS: Tel. No.:&5 /1) .5 — 9�'q Date Filed: d DATE: �5 /�-7 2 0 C�1 . Z L r-A,5 7rn 0,� ('A,/ :�—) G3G@L9MGD AUG 2 7 ?009 HEALTH DEt' i. CG0 ll-f (��� cA2.for?� r4--00 C'2ocr2� P4 I (\) /- ZC, �-