HomeMy WebLinkAbout2014 Jun 30 - Notes on 2012 Jul 24 Transmittal Sheet 6- Sa 4aMi9h/ S cram im
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0 of TOWN OF YARMOUTH$ rao 04_
LIJ ° HEALTH DEPARTMENTtriywohoc.cei
�'' �`%� PERMIT APPLICATION SIGN OFF TRANSMITA't *IEE'l(PrPt
. Ciro be completed by Applicant: �` L /
Utuitding Site Location: 15 �jo��a o �R C W �f (r. , �, �� —
Proposed Improvement: \-21°Q. av c..\ d\ ch
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Applicant: <,,\,s e c •, Tel.No.: ---)'•gel 3'� s
Address: ) 9 K_ -c, \- \.)3 Date Filed:
**If you would like e-mail notification of sign off,please provide e-mail address:
Owner Name: \ \ P •\•
Owner Address: ) ; G.6\ - Owner Tel. No.: `� y-'i 5
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: DATE: 7"-' 4)--
PLEASE
)-PLEASE NOTE
COMMENTS/CONDITIONS:
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