HomeMy WebLinkAbout2014 Sep 04 - Sign Off Transmittal Sheet, Plot Plan - Deck Add-on ,�.�.. .. ,� ,_ ,____ _ _. _ ,_ r_ . -..�.
��oF���G TOWN OF YARMOUTH
-�D ` HEALTH DEPARTMENT
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e '�• •�`�� � PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: I� / ��ST /��ZM�(�7� l�• vV'/ �2�U U i i 1�Ml�
Proposed Improvement: ��' x ay � 7��CfL �4 D� - O N
Applicant: l�l�"TI /'T�� M�I�E�O Te1.No.: / / g,��J�,yo�a�
Address: 3� l�/TI�SD� A�C ' L��M I N S I�E�-� I'''� Date Filed: �'�
••I,fyou would like e-mail notiftcation ofsign off,p/ease provide e-mar!address: /�/��� V�/�/ '��S/ I e.s� C��
Owner Name: I�'I l����� � l�� �N 'V I��J`FE�1�Z�
Owner Address:�� t �• 7��,"1 �V i lf ��• Owner Tel.No.: / 7 0'�5 a�y��
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, . ItESIDENTIAL AND/OR COMhIERCIAL BUILDING
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„ 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 Iceation;
(2.) Floor plan labeling ALL rooms within buiiding
(all existing and proposed)—
Note:F[oor plans not required for decks,skeds, windows, roofurg;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
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REVIEWED BY: DATE: / �L
PLEASE NOTE
COMMENTS/CONDITIONS:
06-26-14;01 :43PM; ;5083980836 # 2/� 2
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