HomeMy WebLinkAbout2015 Aug 13 - Sign Off Transmittal - Use and Occupancyy
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To be completed by Applicant:
Building Site Location:
TOWN OF YARMOUTH
HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
2
Proposed Improvement: V Sr_
Applicant:
Address: 9 a �^ u n 1-1 , at 1 X.
/4
Tel. No.: 61 7
Date Filed: F 7
**If you would like a -mail notification of sign off, please provide e-mail address: C L T 1 " e F'L O ('q.
Owner Name: L(I IV t) A� P F t t F C rc i N
Owner Address: A -L- (�'i'i j
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 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:
PLEASE NOTE _.
COMMENTS/CONDITIONS:
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DATE: (5 ��