HomeMy WebLinkAbout2015 Feb 27 - Sign Off Transmittal Sheet, Floor Plans - Basement Rec Room.�. �_.. _ �
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OF�`-jR TOWN OF YARMOUTH
�� '�-�=�° HEALTH DEPARTMENT
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�'���`' x PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: J�o �RSffl i�E �e �/�,aoa i �e��fY OZG�'
Proposed Improvement:� RA�/�p� �SE�1E�v 1" �C� �o•�
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Applicant: �1oN�l � • �re��'Nu�ooD Te1.No.: 5/,,�:�yQ—��/8
Address: -5�0 / "/A`�tA'S'/�E �., A.lKd1TlI .t T 1�( �16� Date Filed: � �a'r�
--**lfyou would like e-mail notifrcation ofsign o�;please provide e-mai[address: �Qh e n wo� ��� �d�
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OwnerName: Q � •�/1s'6NWt�p
Owner Address: s� ���'SiDE�,Q �Mo �� Owner Tel. No.: 1r0�'-,�1�,
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RESIDENTIAL AND/OR COMNNIERCIAL BUILDING
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:F[oor p[ans not required jor decks,sheds, windows, roofing;
(3.) If necessary, Title 5 application signed by licensed installer
a with fee. �
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REVIEWED BY: DATE: a � I 5'.
PLEASE NOTE
COMMENTS/CONDITIONS:
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