HomeMy WebLinkAbout2011 Mar 11 - Sign Off Transmittal Sheet, Floor PlanTOWN OF YARMOUTH
HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: 5 19 M'I 'r o s T, W. y fhm m o u'TH")A, 02 G `t 3
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Applicant: (= 2z- j< L- v i4C
Address:
**Ifyou would like e-mail notification ofsign off, please provide e-mail address:
Tel. No.: S-u& - S ? - 3 s'�o
Date Filed:. /
Owner Name:OwnerAddress: 131 Owner Tel. No.:
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1 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 required for decks, sheds, windows, roofing;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
REVIEWED BY:
I/ PLEASE NOTE
COMMENTS/CONDITIONS :
DATE:
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MAR 112011
HEALTH Pr.
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