HomeMy WebLinkAboutTransmittal Fill, .*_1'!' _ 4, TOWN OF YARMOUTH
H
iii. r HEALTH DEPARTMENT
°.'L.,"' ' PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
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be completed by Applicant:
Building Site Location: ( 5 S (' 2t I. Sr yAI?A9Cci7 Map No.: Lot No.:
Proposed Improvement: A i j `t b //i 5 aS , P '
Applicant: R A Z p4 (/O 3L Tel. No.: '2 2 -"j (
Address: / (,(/QG ) A / W i& ii7firss Date Filed: z /c-0-16
**Ifyou would like e-mail notification of sign off please provide e-mail address:
Owner Name: f;Z._ph C/ed S6C
Owner Address: ,4 Owner Tel. No.: S.4J 1( '
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) —
1 Note: Floor plans not required for decks, sheds, windows, roofing;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
REVIEWED BY: 6/(Jai ,-,�; -;' DATE: Z /S 6
PLEASE NOTE
COMMENTS/CONDITIONS:
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