HomeMy WebLinkAbout2014 Dec 12 - Sign Off Transmittal Sheet, Plans oF�R,e,� T4WN OF YARMOIITH
�� -�:�[ HEALTH llEPARTMENT ,
i e '��, .••' � PERNIIT APPLICATI4IV SIGN OFF TRANSMITTAL SHEET
Ta 8e compteted by Applicant:
Building Site Location: �� ���G�-
Proposed Improvement: ��' '/`��r�" I�l�}'T"�� ! /�� �`
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Address: '.`S� Ga4G �� Date Filed: � � /dt '
*'[fyou would Cike e-mail notification of sign off,please provida e-mui!address:
Owner Name: �l�i �✓�"Z�
Owner Address: / � ��^` it f� Owner Tel.No.:���G4•�/ iZ�y
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RESIDENTIAL AND/OR COMMERCIAL BUII,DING
HEALTH DEPP,EtTMENT: I?etecmines Compliance to State and Town Regnlations; i.e.,Requirements
For Septage Disposai and other Public Heaith Acdvities.
Please submit three(3) copies of ptans, to include:
(1.) Site Plan shavving existing buildings,water tine locatian,
and septic system iocation;
(2.) Floor plan labeling ALL rooms within buitding
(ali existing and propased)—
Note:FToor plans nat reyuired for decks,sheds, windows, raoftng;
(3.) If necessary,Title 5 application signed by licensed installer
with fee.
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REVIEWED BY:___������^� a__ DATE: ! I� � �
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