HomeMy WebLinkAbout2010 Dec 14 - Sign Off Transmittal, Floor Plan, Photo.Y� TOWN OF YARMOUTH
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HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location:
Proposed Improvement:
Applicant:
Address:
**Ifyou would like e-mail notification ofsign
Owner Name: &\ ftA-*
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please provide e-mail address:
-0--Tel. No.: .ro � (b U( �- -.S ;j
Date Filed: !�
Owner Address: 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.
REVIEWED BY:
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.
.............................................................................................................................................................................................................................................................
DATE:
COMMENTS/CONDITION PLEASE NOTE
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