HomeMy WebLinkAbout2014 Oct 14 - Sign Off Transmittal Sheet - Swimming Pool i
20E=,�a TOWN OF YARMOUTH j
o� _�y HEALTH DEPARTMENT
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���=•%/� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
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To be completed byApplicant. . : j
Building Site Location: � �� �" 7 r �v�"�L� / G-/��'� C�
Proposed Improvement: S 'v S C*t'Z L �'NT'S"� -�'jG✓�/��/Ci JZXJ
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Applicant: S�GvLELi�1� ��C S LN C Tel. No.: S�� '�'�' 9G� �
Address: 7d� G1' u�"F^� IT'4"�� "�� �/�U�C�� Date Filed: /� �� /�� �
**lfyou would like e-mail notification ofsign off,please prwide e-mail address:
Owner Name: .���'hrcS �'rly c�
Owner Address: / ZS ~"�`��f'�G�=-� 7��2'?�CC Owner Tel. No.:�� "3�0 r G2�
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RESIDENTIAL AND/OR CONIlVIERCIAL BUILDING
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements
For Septage Disposal and other Public Health Activities. -- - - I
Please submit three (3) copies of plans, to include: i
(1.) Site Plan showing existing buildings, water line location, �
and septic system location; i
(2.) Floor plan labeling ALL rooms within building �
(all existing and proposed) —
Note:F[oor plans not required for decks, sheds, windows, roofing; i
(3.) If necessary, Title 5 application signed by licensed installer I
with fee. I
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REVIEWED BY: / � r ''� /��� DATE: � �� �
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PLEASE NOTE
COMMENTS/CONDITIONS:
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