HomeMy WebLinkAbout2020 Mar 31 - Sign Off Transmittal - Demo of=°�4k TOWN OF YARMOUTH
.,�. HEALTH DEPARTMENT
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�.�.,t`< PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
t .To be completed by Applicant:
- Building Site Location: .2a_t I
Proposed Improvement: f� 12-Gh' C.,3
I Applicant: \IC,m. 61j1.h,c, Tel. No.:
Address: ' 1C T Date Filed: 02/101 : 020I
**lf you would like e-mail notification of sign off please provide e-mail address: 7:711 t';rj f) I Mr a 'r-e f ek-o.i,ri-,f i Co
Owner Name:, - ,1 o 2.I cp, 1
Owner Address: /3 `i fic G•.4sr F,'( ,. , Owner Tel. No.: 77 ii 7( ,
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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.) ASite Plan showing existing buildings, water line location,
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Viand septic system location;
(2.) Floor plan labeling ALL rooms within building
(all existing and proposed)
Note: Floor plans not required decks, sheds, windows, roofing;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
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REVIEWED BY: l ► 1 ' (. DATE: -2-7/3I Z
PLEASE NOTE
COMMEN S/CINDITIONS:
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