HomeMy WebLinkAbout2014 Nov 26 - Sign Off Transmittal Sheet, Plans - Garage oF�qk TOWN OF YARMOUTH
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� -X���y HEALTH DEPARTMENT
� ��'���? PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
� T be completed by Applicant.• �
� B ilding Site Location: � � � � � ����^ S 1 �U�`^ `l���`Gv�'^
Proposed Improvement: (�+2C^O�Q � qa�a� 2��5�P� O�r�C�
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��c,C� -����SL.P o�C 'c�S 5'I�d �o n�n- �� T 1CNo.: So� 6`IA ' �`t �a
pplicant: � 2 4�q<Gn,
Address: �� �V C�C �S� M�15 � w��1 S • �j�� MO V1��n Date Filed: � � - r�, ro "��
'*Ifyau would like e-mail notification ofsign off,please prwide e-mail address: C I�S�U M C C C1�'�'�'e� C C��'Ci r��',
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Owner Name: K r^��`e e n O M O� '��
Owner Address: � � ` � l S a�-�"' S� Owner Tel.No.: (�� � � �1 a� ' ��9�
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RESIDE AND/OR COMNIERCIAL BUILDING
HEALTH DEPARTMENT: De mines Compliance to State and Town Regulations; i.e., Requirements
F Septage Disposal and other Public Health Activities.
� \ 1 Please submit three (3) copies of plans, to include:
�w (1.) Site Plan showing ezisting buildings, water line location,
and sept�c system location;
� (2.) Floor plan labeling ALL rooms within building
(all ezisting and proposed) —
Note:Floor plans not required for decks,sheds, windows, roof�g;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
.............._................ ......................_............. ........_.............................................. ............................................................................................................................. . ..
.................................................
REVIEWED BY: DATE: I��` �/� 7�
PLEASE NOTE
COMMENTS/CONDITIONS:
��
_ T__ _____ _ _ __. ____ _ _ _
�of�?.� TOWN OF YARMOUTH '
3 ' `_`c HEALTH DEPARTMENT
� "^�_^°`' x PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
t i
To be completed by Applicant.•
BuildingSiteLocarion: / � ` � � ���h S� �cJ�\" `����G"�� ;
Proposed Improvement: (�e("�O�Q `� qa�aq eS�5�Pu � ��
� c� ��UC� b X 7i(o � Cci� 0. Ci Ci-J �'w. f�G Ic�r^^ 1 �
cs c G,ec.t. �, �,� looc -tn e O Q� c,
SQ�C� -� ��5�.e o�C 'C �S S'1� ��non- cor.ecc�c,
Applicant: � 2� �qCvl�, Tel.No.: So 8 6 y � � ��t 3a
Address: (� �\ C�C �S� M�IS �q�t S • �(�� M��l^ DateFiled: � I - � F1'��
*'Ifyov wouldlrke e-mail notification af sign ofj,please prwide e-mail address:_C C.>51 V M C C C�'F'�'e0 C C�"' 1 \�•
OwnerName: �Cn'Nn,eQ(� OMo� ��� co�^
Owner Address: � � ' � l S c,�-�'^ S`� Owner Tel. No.: �� � ' ��a� - I�9�
S, ._�j._�S._�^_o u'E'�n..........._r'��......_....._..._d_a(�_6�1....................
_..............
RESIDENTIAL AND/OR CONIMERCIAL BUILDING
HEALT'H 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; I
(2.) Floor plan labeling ALL rooms within building ',
(all ezisting and proposed)—
Note:F[oor p[ans not required for decks, sheds, windows, roofing;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
....... ........_............................................ .... ................................................... ................................................................................................................T....,��.......
REVIEWED BY: DATE: J 1 a � I �j(
PLEASE NOTE
COMMENTS/CONDITIONS: