HomeMy WebLinkAbout2010 Apr 23 - Sign Off TransmittalTOWN OF YARMOUTH
HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
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Building Site Location: % ' %�`f &`�" 1 v V � ?�ap No.: � � Lot No.: �
Proposed Improvement: YZ � (
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Applicant: rt,k Tel. No.: 36 ` Z 3
Address: �VCiBS 7'�It / 6 � 1 cs01 v 71�1 1�� ��?�% Date Filed: V 23v
**lfyou would like e-mail notification of sign off, please provide e-mail address:
Owner Name: /_�d 4t-17 � r 7"
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Owner Address:. b , `rat Wpx e,-f Owner Tel. No.:
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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;
(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: DATE: C d 3
PLEASE NOTE
C ONIWNT S /CONDITIONS :