HomeMy WebLinkAboutSign off Transmittal 2007 Living Rm Expansion TOWN OF YARMOUTH
„ HEALTH DEPARTMENT
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"' ""°" g: PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant'( '
Building Site Location: G E rD Map No.: Lot No.:
Proposed Improvement: L 1 V t L C � o
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Applicant: CA4 r. • Tel. No.:Ly l-f' 3'2.-2SI�....
Address: 33 G C \h ars& 7 tf") r w o IJ /AA )--er5 t Date Filed: S ' •OR-
**Ifyou would like e-mail notification of sign off,please provide e-mail address:
Owner Name: C 2Lc k), T'2 •
Owner Address: G N CGvQ , A .\/,4,(2,M G(C'4 Owner Tel. No.:61+-- S to -lb-31r
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 four(4) copies of plans, to include:
(1.) Site Plan showing existing buildings, water line location,
and septic system location;
6-12.) 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
•th fee.
REVIEWED BY: / DATE: J /615/C)
PLEASE NOTE
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