HomeMy WebLinkAbout2020 Jan 23 - Sign Off Transmittal, Floor Plan :Y4kTOWN OF YARMOUTH
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HEALTH DEPARTMENT
` PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: 5 i B Rol Eau /
Propos �I)mprov }m/ ve��n�t::�o...„,: ...+ 0 &.'.L A. 66%.. _0' 14.4_44 ' • etoot t
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Applicant: f 4 t 4
Tel. No.*
8 `f t�;�: 264Z.3 .
Address: Date Filed:
**/f you would like e-mail notificatio of sign off,please provide e-mail address:
Owner Name; ' I a'
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Owner Address: .l �' ;' ' t '., S 4 b Owner Tel. No.: $ 324
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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.
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REVIEWED BY: 11
DATE: 1/01j � 13\0" �,1 .
PLEASE NOTE
COMMENTS/CONDITIONS:
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