HomeMy WebLinkAbout2006 Jul 05 - Sign Off Transmittal SheetTOWN OF YARMOUTH
HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAI<, SHEET
To be completed by Applicant.
Building Site Location:
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Proposed Improvement:
Map No.: Lot No.:
Applicant: / 6, LW Tel. No.:-;;
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Address: c f i' 4 . Ii q Date Filed:
**Ifyou would like e-mail notification of sign off, please provide e-mail address:
Owner Name: 11"e', % l )� " Ca 1.e /
Owner Address:-- �� '' r � �� � /3 r.
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Owner Tel. No.: S O k.._'1'2 `. � ; y
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. ,
COMMENTS/CONDITIONS:
0
PLEASE NOTE
DATE:
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