HomeMy WebLinkAbout2019 Oct 16 - Sign Off Transmittal - Use & Occupancy TOWN OF YARMOUTH
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HEALTH DEPARTMENT
\::: PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant.
Building Site Location: 96cud, . C-
Proposed Improvement: S f <C4941",---\ Ej e e -y2
Applicant: %.7775-4-1 41/c..t -. l(G <11(/‘°5-
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Address: 9G(1- --Pc-4-'t Date Filed: /v
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**/f you would like e-mail notification of sign off please provide e-mail address: G
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Owner Name: f'V-'"`
Owner Address: 9.31-- G `r D Owner Tel. No.: 5 ►^"
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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: if12,, /A , DATE: ,,16// 9
PLEASE NOTE
COMMENTS/CONDITIONS:
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