HomeMy WebLinkAbout2019 Jul 15 - Sign Off Transmittal, Plan - Inground Swimming Pool of ,y TOWN OF YARMOUTH
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HEALTH DEPARTMENT
Ge.`; " PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
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Building Site Location: _ ,/ • 67'6.
Proposed Improvement: i PV V flu', L--° v, +'-t '%l 19( '• x
pp fCgS ar bJ�(EC' 1�C (1-co�) r ' 073
Applicant: �� � Tel. No.:
Address: 1/6 O S 14C-5/. /f"( '` 4"14(4151/111-hDate Filed: 0?,/r//r.
**If you would like e-mail notification of sign off please provide e-mail address:
Owner Name: 4,-- `9- 1 U rti1A1-42(3
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Owner Address: (,./r),-C� tet' L 1 ' t/'` ` ' t`�' f' Owner Tel. -N) �U
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: y'�V ` DATE: 7 7(
PLEASE NOTE
COMMENTS/CONDITIONS:
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