HomeMy WebLinkAboutUntitled °f o, TOWN OF YARMOUTH
c: HEALTH DEPARTMENT
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4a`Nop,AnDO '' PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: Map No.: Lot No.:
Proposed Improvement: (4 /"\ �L '
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Applicant: Tel. No.:
Address: Date Filed: toll il c>C
**If you would like e-mail notification of sign off,please provide e-mail address:
Owner Name: t
Owner Address: E 5 RJ 5 Ya s Owner Tel. No.: c"' `" t 4
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: DATE: 10 /GAG
PLEASE NOTE
COMMENTS/CONDITIONS:
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