HomeMy WebLinkAbout2011 Feb 08 - Sign Off Transmittal, Floor PlanTOWN OF YARMOUTH
HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: V e
Proposed Improvement: �c r E.
Applicant: Tel. No.:
Address: JAA 14 & Date Filed: 2
**If you would like e-mail notification of sign off, please prQZde e-mail address:
Owner Name: e
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Owner,Xddre7ss: U 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:
(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�re4uiredjbr decks, sheds, windows, roofing;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
A.
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REVIEWED BY: DATE:*
/PLEASE NOTE
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