HomeMy WebLinkAbout2008 Aug 21 - Sign Off Transmittal Sheet, Plan - Proposed Deck , .
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,�°��Y��o TOWN�OF YARMOUTH ;
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o _ y HEALTH DEPARTMENT
��MATTA N 5 � � - � �
� �"°"""°a��'� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET !
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To be completed by Applicant: �
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Building Site Location: �� ������"'� /�� / � � Map No.��S Lot No.: yZ y �
Proposed Tmprovement: ���L�G� CG b �StCK- '
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��PPlicant: ���ilr��� t� . �,2C�?'t/ Tel. No.: ���• ��8,.3.3'��o �
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Address: �a ����o�if- �� �� Date Filed: `�� ���� ��'' '
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**If you would like e-mait notification of sign of�;'please provide e-mail address: �/!'"�`'� � 7' /'� �
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Owner Name:_ /�tl����� � �7.P�fit� „ �
Owner Address: d� �'L���'�C'� '�� �' � Owner Tel. No.: ���`��' `�'�y�
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RESIDENTIAL AND/OR COMMERCIAL BUII.DING �
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HEALTH DEPARTMENT: Determ.ines Compliance to State and Town Regulations; i.e., Requirements �
For Septage Dtsposa.l and other Public Healt�i Activities.
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� Please submit four(4) c4pies of plans, �o include: � �� � � �
(1.) Site Plan showing ezisting buildings, water line location, �
and septic system location;
(2.) Floor plan labeling ALL rooms within building i
(a�l ezistiag and proposed)— '
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Note:Floor plans not required for decks, sheds, windows, roofing; �
(3.) If necessary, Title 5 application signed b� licensed installer '
with fee.
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REVIEWED BY: DATE: ' �l `�
PLEASE NOTE �
COMII�NTS/CONDITIONS: ,
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