HomeMy WebLinkAbout2008 Nov 03 - Sign Off Transmittal, Sketch - Finsh Basement: Playroom , T -' �--.- -' —''- --•n,.•-- r--;,!9� NAT
TOWN OF YARMOUTH
° HEALTH DEPARTMENT
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PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: .3 /4'rr p orn C /A-;,, tw ie- Ma No.: Lot No.:
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Proposed Improvement: ii-N/94 ✓/t SCA- —r i /2.,U eikA"+' 4 r (10 1C Ye- Ac cAM
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Applicant: C'_`;- ..A t't” 1 Tel. No.: 7 /-727-
Address:
-727_Address: 3' f //cam( t,j 74,2 ►d /1 poz.r Date Filed: I//3/0 '
**Ifyou would like e-mail notification of sign off,please provide e-mail address: (f✓r( k!-ei . it d +4i I pkvl
Owner Name: IC A s ,A--.ova
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 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: ATE: 11 '/3/0 a
PLEASE NOTE
COMMENTS/CONDITIONS:
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