HomeMy WebLinkAbout2018 Dec 11 - Sign Off Transmittal - Shed ,o ; „ TOWN OF YARMOUTH
- HEALTH DEPARTMENT
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'�/ PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: / ( 4 j LI) i'41•-‘.v.ca O
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Proposed Improvement: C C j � U, �, " , (;)YO
Applicant: .� t L �. L A- t -��. 1 Cf
PP Tel. No.:`�� ;71L(.6 /
Address: / XC''' X'I S Date Filed: t /c t Lzoiç-'
**lfyou would like e-mail notification of sign off,please provide e-mail address:
Owner Name: <j4-+ .1 s ( , J4c.1- —
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.
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. r
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REVIEWED BY: � --�-� DATE: / ////
PLEASE NOTE
COMMENTS/CONDITIONS: