HomeMy WebLinkAbout2014 Oct 01 - Sign Off Transmittal Sheet, Plan - Convert Garage to Bath,Laundry Room __-__ _-•--.,..--- -�.,.--:--��------ _..� _ �._ _ �- m
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. ;"R�, ' - TOWN OF YARMOUTH
-� �ALTH DEPARTMENT
� °•�••`` � PE�APPLICATION SIGN OFF TRANSMITTAL SHEET
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To be completed by Applicant: „o+
Building Site Location: O � ( 4 t- 't �� �c S � \'�,r rh a✓ �(� � /� CJ�?�, 'j 3
Proposed Improvement: �r a,., g ��r w� G A�A a e � -� �o b o.��. �L a...��fi�, K����� �'°^ �`%
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Applicant: �'q � �,"r k 1-a n ., � n Tel.No.: S�& - 3 9 y- 7�9 °I
Address: �6 I TA�� �c�. �< s � Yra r.�u✓ � � Yi�� Date Filed: �Q 1 �
•*Ifyou would like e-maiJ notification ofsign off,pJease provide e-mai!address: P4�t q n�o,�d a� /43 q ,.-i e 1 �c,�.�
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Owner Name: �4�� � c�� F�, h r o✓� , ,
Owner Address: �5'1 T1 ��1 ��1 l,Je 5� �rr,�;3 �� Owner Tel.No.: 5��s 3 9�_ 7 7 4 `J
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RESIDEN'C�1I.AND/OR COMMERCIAL BUILDING
I HEALTH DEPAItTMENT: Determines Compliance to State and Town Regulations; i.e.,Requirements
For Septage Disposal and other Public Health Acrivides.
Please submit three (3) copies of plans, to include:
(1.) Site Plan sLowing existing buildings,water line location,
and septic system location; 1
(�.j Floor plan labeling ALL rooms within building
(all ezisHng and proposed) —
" Note:Floor plans eot required for decks,sbeds, windows, roofing;
(3.) If necessary, Title 5 application signed by licensed inst�ller
with fee.
REVIEWED BY ....__ .. _...................................................... _.............. ..................DATE:..... /G / � ......C..............._..........._.........._........
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PLEASE NOTE
COMMENTS/CONDITIONS: �(�,� /� f
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