HomeMy WebLinkAbout2012 Apr 25 - Sign Off Transmittal, Floor Plan SketchedTOWN OF YARMOUTH
HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location:
Proposed
Address: J S PI't 1', t�``m D P ,,/-,. C' c/ '2 ^ "" 2 e140- Date Filed: V Y
**Ifyou would like e-mail notification ofsign off, please provide e-mail
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Owner Name: o " ; '30
Owner Address: `_,/ c4zZ 13c,-)4,1 A! Owner Tel. No.: 98 �
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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: ),-' —DATE:—C/ C�
PLEASE NOTE
COMMENTS/CONDITIONS—
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