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HomeMy WebLinkAbout2019 Jan 31 - Sign Off Transmittal Sheet, Floor Plans I �t:YA
dr TOWN OF YARMOUTH
HEALTH DEPARTMENT
1('r`sem, /44
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, PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: 44 .r �', '/r' r,'; ' .c't
Proposed Improvement: '(1/11(//, ( ;L ;LI + to/7 l
Applicant: f I I (114/1/,-) (1C:_)" Tel. No.: f:J /Tie- `%'('t
Address: ` 1/7/, i;'/ ,/t/ r-r f'!'t ii '' (7/ . Date Filed:
**ifyou would like e-mail notification ofsign off please provide e-mail address:
Owner Name: ,`'1/ L._ - (/ / S
Owner Address: ."j -i 1 r/, . r: f. �__ f ,
.� l � 1 f Owner Tel. No.: 7,", /;',i, -_ t /
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: `t'' (..A:61,2(141,1, DATE: / 9/
PLEASE NOTE
COMMENTS/CONDITIONS:
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