HomeMy WebLinkAbout2010 Aug 06 - Sign Off Transmittalr .Y
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TOWN OF YARMOUTH
HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location:
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Applicant:V,�-"'Z' Tel. No.�7/7%:jd/4i
Address: Date Filed:
**Ifyou would li w-e--mail not ificati n of sign off, pleas provide e-mail address:
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Owner Name: \
Owner Address: V-2-�N � � `,f I r'�`I Owner Tel. No.:O--ZED
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:
PLEASE NOTE
COMMENTS/CONDITIONS:
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DATE: &! 6 %d
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