HomeMy WebLinkAbout2014 Nov 17 - Sign Off Transmittal Sheet, Floor Plan - Mud Room ,Of�'9R,� TOWN OF YARMOUTH
y�� ��� HEALTH DEPARTMENT
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� '`�•<���� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Appdicant:
Building Site Location: �� ��T"� �L!
Proposed Improvement: �Q � x �o �vfl �UDI'1't
Applicant: �'1� 2 � Y ���G ZiA��'e�Y.�No.: 7 7 4/ "3 J Z (JSf�S
Address: � / " Date Filed: �� � 7 ! �
"'Ifyou would[ike e-mail notifrcation ofsign oJJ;please provide e-mail address:
Owner Name: �/'{� � �b/�°(��'
Owner Address: � � ��?/ �./fs Owner Tel.No.: 77�-3/�DS�S^
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RESIDENTIAL AND/OR COMMERCIAL BUII,DING
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 locafion; -
(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.
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REVIEWED BY: DATE: )� � / `
PLEASE NOTE
COMMENTS/CONDITIONS: