HomeMy WebLinkAbout2014 Nov 07 - Sign Off Transmittal Sheet, Plans - Accessory Apartment 2aF�R,� TOWN OF YARM4UTH
r�� HEALTA DEPARTMENT
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�`���, �°' � PERMTT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
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Building Site Location: '-!O t� W r s r �(a<z_m3 � R-d W �`�r+-amo-x'�-
Proposedlmprovement: (3--cS�D r� �r�... lti �2<<--r�ce-o {a.�.e, aee«<w�� A�Ar�xr�n-r
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Applicant:Ghct.� C.�rr�...�. Te1.No.: 38�-'7bY4'
Address: �� C�x_�w,..� C.tJtz,� Zienn�� DateFile�: �1 � j -
*'Ij'you wou/d like e-rnail not�cation ofsign o,�;please provide e-mai!address: fi 2i G.cx�o.�y� �Y nc.�
UwnerName• �ha�a.. �./CY�Gtrf6-
Owner Address: �}o U f �o., �ct . Qwner Tel.No.: 8G a--3T"I-�t�'tI
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RESIUENTIAL AND/dR CONIl�IERCIA.L BLIIt.DING
HEALTH DEPARTMENT: Determines Comglianee ta Siate and Tawn Regulatians; i.e.,Requirements
For Septage Dispasal and other Public Health Activities.
Piease submit three{3) capies of plans, to inciude:
(1.) Site Plao showiug existi�g buildings,waker line location,
and septic system location;
(2.) Floor plan labeling ALL rooms within building
(all existing and propased)—
Note:Floor plans not r�quired for decks,sheds, wandows,roofrng,
(3.) If necess�ry, Title 5 application signed by licensed installer
with fee.
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REVIER/EDBY: ��%' DATE:_��� 1�
PLEASE NdTE
COMMENTS/CQNDITIONS: '
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NO 0 7 2014
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