HomeMy WebLinkAbout2015 Jan 15 - Sign Off Transmittal Sheet, Plan - Storage Barn _ __ _ _ _ .
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�otw`'k,�o TOWN OF YARMOUTH �
Q�� =�y HEALTH DEPARTMENT i
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�-•'' PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
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To be completed by Applicant: I�pv-rE (o /� ' i
Building Site Location: ���� �`��� �� S � ��7��t�o�T�/��d �` �
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P�roposedImprovement: ��)r? S�C!-vct /6 a' �1Y S�i�rr-s< <3pri7 /^'lonoL.'7�F� � S/w(3 �
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Applicant: I� �/ < ��^'� �o � � Tel. No.: S�Y'`f3d -��o� �
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Address: �s ` Q�Pe�� f�n/7c p/� /�iasw :c(-( /��,� p�6 `FS DateFiled: �� !� ;
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"Ifyou would like e-mail notifrcation of sign off,please provrde e-mail address: �
Owner Name: 15 5 �' {� �w ���c U�� '!
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Owner Address: ���6 t`7�r'r� S f" � � f/� �.� � T Owner Tel. No.: ���' ��5 -Ga 3� i
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RESIDENTIAL AND/OR COMMERCIAL BUILDING i
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HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements �
For Septage Disposal and other Public Health Activities. '
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Please submit three (3) copies of plans, to include: j
(1.) Site Plan showing existing buildings, water line location, �
and septic system location; �
(2.) Floor plan labeling ALL rooms within building �
(ail existing and proposed) — i
Note:Floor plans noi required for decks, sheds, windows, roofang; �
(3.) If necessary, Title 5 application signed by licensed installer j
with fee. �
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iREVIEWED BY: � DATE: / ��_ I
PLEASE NOTE
COMMENTS/CONDITIONS: i
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