HomeMy WebLinkAbout2020 Jan 14 - Sign Off Transmittal Sheet - Above Garage Bedroom 1 0�= l► TOWN OF YARMOUTH
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`+ ` ° HEALTH DEPARTMENT
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-' PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant:
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Building Site Location: 7 4---/itpjAvie.fize 1e -. f i.t't''t�l
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Proposed Improvement: ,,, :eiVe._ _ .......4-7/ .2. --> ed, .
Applicant: i I- X.kDefrid0,07.01.'1.--re,_ Tel. No.: 554?-s?6,/--4' f
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Address:Pl• "74 C. .M -sz u�*a.." 'Lt Date Filed: t 2
**Ifyou would like e-mail notification of sign off,please provide e-mail address: r-,et-r e 2ied,../:2 0n • f
Owner Name: / L.4 D—Z414"Pil.00f-e..--€
Owner Address: 5",‘,...,.._,..e Owner Tel. No.:
RESIDENTIAL AND/OR COMMERCIAL BUILDING ''°
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; ii\ Requirements
For Septage Disposal and other Public Health Activities. •
Please submit three (3) copies of plans, to include: x_,
(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.
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REVIEWED BY: /Or
DATE: l iOGhC
P EASE NOTE
COMMENTS/CONDITIONS:
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