HomeMy WebLinkAbout2019 Oct 09 - Sign Off Transmittal - Demo of TOWN OF YARMOUTH
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HEALTH DEPARTMENT
`'. PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: 1�
Proposed Improvement: -DE"../tit(1�-- 1 -71 )/-.I �_ . /t 1I,,-L.- C V --t fl 6 r-
Applicant: U,-`'-' -k . . �-'=� `- -- CO - c,..(.::�_ 1` - 7
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> f : - n `;Address: - ( (- J ) ‘ . -,
Date Filed: („) `"7 I '
**If you would like e-mail notification of sign off please provide e-mail address: - � - +.` i \'.-: c,_,V C 'A.5 Cut, I(6,,A„,,,,:).
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Owner Name: 0 Dv .i:' _Z1 ��
Owner Address: c-. `' \ -It- ?"5 UJ, Y A:PA(;J
Owner Tel. No.:
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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: �� ,-- -Y1," S�
DATE: 7
PLEASE NOTE
COMMENTS/CONDITIONS: