HomeMy WebLinkAbout2015 Feb 02 - Sign Off Transmittal Sheet - Screen Porch over Existing Patio . _ . .�,. ���._, .
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OF�'9R,� TOWN OF YARMOUTH
�� � `'�� HEALTH DEPARTMENT
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��'��=��y PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
BuildingSiteLocation: �O (�Jl'�"gF�l.� �'E , (..1� Y`}QMOVCi'�
ProposedImprovement: 11.1 .S(.f�'iSN (l)1�F�}I a�'�--Z- �'sT"SNG ,,,o
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Applicant: ���p4(Z (�A'0/N�� Tel.No.: S�� 73�. ' 4 6�3
Address: a�k �b1b , wwf�s r�w s My�S , I�41a 6�'�8' Date Filed: Z 2 ��S
*"Ifyou would like e-mail notifrcation ofsign off,please prrnrde e-mail address:
Owner Name: UQUI�-- FIWi�1��12{s
OwnerAddress: ��° (,d�}3.�FL� 'IY� � � OwnerTel. No.: ��� �� `27Z�
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RESIDENTIAL AND/OR CONIMERCIAL BUII.DING
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements
For Septage Disposal and other Public Health Activities.
Please submit three (3) 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, rooftng;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
REVIEWED BY: DATE: � � �
PLEASE NOTE
COMMENTS/CONDITIONS: