HomeMy WebLinkAbout2009 Sign off Transmittal - Demo / Replace Deck°� .Y� TOWN OF YARMOUTH
HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: � � l�fh f�Otti .< Map No.: r,' Lot No.: / , cr
Applicant: Tel. No.:
Address: V Date Filed:
**Ifyou would like e-mail notification ofsign off, pleaseprovide a -mail address:
Owner Name:
Owner Address: ! / �, Owner Tel. No.: Jr( 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 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: X% & rl m i✓ ✓ i" DATE:
PLEASE NOTE
COMMENTS/CONDITIONS:
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F CERTIFIED PLOT PLAN
LOCATION /if Mql(l
SCALE. DATE .k/!�I/ o.q..
PLAN REFERENCE.
.........................
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I CERTIFY THAT THE
SHOWN ON THIS PLAN IS LOCATED ON THE GROUND
AS SHOWN HEREON (:)
DATE.4�;/�7,,
"WEST Yqr4)lvla.7*6 XPI.
REGISTERED LAND SURVEYOR