HomeMy WebLinkAbout2008 May 07 - Sign Off Transmittal - Proposed New Home _ Tt3 VN OF YARMOUTH
r HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: 620 6 Wi p Map No.:qc Lot No.:c '(c
Proposed Improvement: 5 \ c((..e (44 t� \ 11th
Applicant: (..,D([ IG tM ?row Tel. No.:S66-'36)-6 61
Address: Pt V , o '( 5W J ri YI/Wy/t44 (6s-' Date Filed:11—).--C'"-C4?
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**If you would like e-mail notification of sign off,please provide e-mail address:
Owner Name:
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Owner Address: f , ,K S% C)�‘c-0? Owner Tel. No.: -3C'6 lC9
RESIDENTIAL AND/OR COMMERCIAL BUILDING
HEALTH DEPARTMENT: Determines Compliance to State and Town R ions; i.e./Requirements For Septage Disposal and other Public Health ' iv ies. ..
Please submit four(4) copies of plans, to include:
(1.) Site Plan showing existing bdings, 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: /7416/a,./0€&, DATE: '" `e
PLEASE NOTE
COMMENTS/CONDITIONS:
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