HomeMy WebLinkAbout2006 Jun 30 - Sign Off Transmittal Sheet, Floor Plans - OccupancyTOWN OF YARMOUTH
o _ y HEALTH DEPARTMENT
N MAT TA M ESE
WED PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant: �q��>>d ti77 o� " o .z G
Building Site Location: a/, A Map No.: Lot No.:
Proposed Improvement:
Applicant:
Address:
**If you would like `e'-mail notification of sign off, please provide e-mail
Owner Name: _..---�1 • // r, 7 C t 1,010
Owner Address:
' Tel. No.
Date Filed:
/7 d
Owner Tel. No.
6 r 1 /i
'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:
(1.) ✓Site Plan showing existing buildings, water line location,
and septic system location;
a(2.) Floor plan fafiel`m'`g'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:
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PLEASE NOTE
COMMENT S/CONDITIONS :
SKETCH ESTIMATE
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