HomeMy WebLinkAbout2014 Dec 19 - Sign Off Transmittal Sheet, Plan - New 2BR House �yF„�?:.A�� TOWN OF YARMOUTH
�$ �- - c HEALTH DEPARTMENT
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Y�='���� PERMIT APPLICATIQN SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: � � °�`�-' �--A�-e �5'L �A" yr�.v�h
Proposed Impravemant: 1JEU-> 2 `t✓�-2S Ra6�'t S �-tor�n�
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• AFplicant: ���e,"�p�r �y�a��.�t '� �c, � Tei.No.: �D k -3 S Y ' 22�1 3
Address: 2t� t�J otLVv� Mn t,: S�'� Sb U�Jcr V�'""�'""'°' Date Filed: ��.—�j ^ 1 y I
**IJ'you would like e-mail notification ofsign aJj,pdease prwrde e-mail address: /2`��1"��T �7�G�I��i"fii�� �/vYr �� �
OwnerName: ��H� �� ��OV�Q.GI-1 '
�� 4wner Address: -3� �l��M /"t 1I �d! ` Owner Tel. No.: 7? �-ZI.� -11$Z I
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F RESIDENTIAL AND/OR COMMERCIAL BUILDING i
HEALTH DEPART1v1EN"f: Determines Compliance to State and Tawn Regulations; i.e.,Requirements ` j
� For Septage Dispasal and ather Public Health Activities. ' ?
Piease submit three{3} copies af pians, to include: 1
(1.) Site Plan showing existing buildings,water lioe location, '
and septic system location;
(2.} Ftoor plan iabeling ALL rooms within buitding i
(all existing and proposed)– �
Note:F[var plans xot required for decks,sheds, windows,roofuag; i
(3.) If necessary, Title S applicatian signed by licensed insta0er �
with fee.
_..........................................._..............................................._,................................._.............................................._............................... ............._...................................................................._..........._.............................._
REVIEWED BY: _I�C1(f� GC�.PI DATE: /�L ' /f�/�
PLEASE NOTE , �
COMMEN�/CONDITIOI)iS: � �j � ` �
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