HomeMy WebLinkAbout2006 Sign Off Transmittal - New Module Home •J
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TOWN OF YARMOUTH
• 13t.1 HEALTH DEPARTMENT
••� 'MATTA M ESF/� ',
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: 7#1f�����- � fi,i/ �i Map No.:/( Lot No.: _.1
Proposed Improvement: ���� n?P�,�l �, ,2, 7--A
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Applicant: Tel. No.:552A/-
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Address:S/S 41r c eMOCA Date Filed:I//3/ 6
**Ifyou would like e-mail notification of sign off,please provide e-mail address:y/ t/9‘,7/ r('.,c,
Owner Name- \,0 y
Owner Address:q k (1, i U te i -u Owner Tel. No.i..5 ,5q14 OSS( 3
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;
(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: 0 (ir. / DATE- 87,27-e;C
PLEASE NOTE
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