HomeMy WebLinkAbout2014 Feb 21 - Sign Off Transmittal, Floor Planoff:''—�qR
TOWN OF YARMOUTH
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HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant: p'--< -1) c k,;r
Building Site Location:
Proposed Improvement: (__k'
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Applicant:.. Is � t 14 Tel. No.;
Address: 61 SF-c�i-<-r r c, U,,_ t-k� �,n n t 'C) 60 1 Date Filed: �> :� 1 � %`r'
**Ifyou would like e-mail notification ofsign off, please provide e-mail address:"
Owner Name.
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Owner Address:,.",,o 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.
Please submit three (3) 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:
COMMENTS/CONDITIONS:
DATE:
PLEASE NOTE
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2014
HEALTH DEPT.
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