HomeMy WebLinkAbout2015 Jan 06 - Sign Off Transmittal Sheet - Demo .otCA�.� TOWN OF YARMOUTH
s'?�e HEALTH DEPARTMENT
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���'' � � PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
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To be compdeded by Applicant:
Building Site Location: � �ML-��� ��
Proposed Improvement: f'� , t,�c r_ �_ n�,����/� A�„i�Z�i�KJ } <_�c���i �G S`-S i� �
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Applicant: � ltc r�f'ss �i Nc,`Lt�� Tel. No.: ��'��y ���
Address: I � � /� { J il L.z �D. ��%��t+R,�a.o v a++ yl/1✓` O ���� Date Filed: /-6 '1 S
*"Ifyou would like e-mai/notification of sign ofj,please provide e-mail address:
Owner Name: �`�t c ttH tt- �Q��+^�w
Owner Address: � L: ,�1 CYZr1tD �vt w�s J �.^w�-�1 Owner Tel. No.: `���-�`%`�- a 3��
RESIDENTIAL AND/OR COMMERCIAL 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:Floor plans not required for decks,sheds, windows, roofing;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
REVIEWED BY: t� G CP/G'lSGG�F' DATE: I � G% �S�
PLEASE NOTE
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