HomeMy WebLinkAbout2014 Dec 30 - Sign Off Transmittal Sheet, Floor Plan - Bedroom, Dining Room, Bath, Front Porch _ .�.�. _ _ _ _
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ot-Ya� TOWN OF YARMOUTH I
�2 ��� HEALTH DEPARTMENT I
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��'ti=•%� � PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET i
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To be completed by Applicant.•
Building Site Location: /��`� S�/A�J�� / JLC�/
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Propose Improvement:�,(j,(, ��f�,L�/�/d/,�{�j �/y ��T,�/ I
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Applicant: ���ti ��� Tel. No.:��L�! �,
Address: ��S S'�'j'/,�//�7�C� l"/�iPJaT Date Filed��'� ��
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s`/fyou would like e-mail notrfication ofsign off please provide e-mai!address:
Owner Name: ��-{�(/ �/1/�%S
Owner Address: ��S'fTL/C',E��'T Q G Owner Tel. No�--=�/
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RESIDENTIAL AND/OR COMMERCIAL BUILDING `- ';
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements I
For Septage Disposal and other Public Health"7�ctiviCies.
Please-sabmit three�(3) copies of plans, to incluc}e,: , �
(1.) Site Plan showing existing buildings, water line location;°
and septic system location;
(2.) F1�0"r plan labeling ALL rooms within building
(all existing and proposed) — � "' I
Note:Floor plans not required for decks,sheds, windows, rooftng; �, !
(3.) If necessary, Titte 5 application signed by licensed installer
with fee. I
REVIEWED BY: ! ' _DATE:��o�/ �
PLEASE NOTE �
COMMENTS/CONDITIONS: �h
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