HomeMy WebLinkAbout2014 Oct 15 - Sign Off Transmittal Sheet - Use & Occupancy �_ � _ _. _ ____� . Y_ �� _ �
Of���,5, TOWN OF YARMOUTH ��.
o� -�� HEALTH DEPARTMENT '
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^�•` PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant.
Building Site Location: 7- 3 O �)�,!t` 5 '�a� 5,,,. i!, (,�r�,,•,,y� �, i �.
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Proposed Improvement: ���J L '
Applicant: /'ri/ r �TI'Y11�� c P--� T���i.� Tel.No.: �fl���'�����,-
Address: Z. �i GJ��.�s' > �� �� S Uu-r rr���� �Date Filed: /� /�/t/ '
"I,jyou would like e-mar/notifrcation ofsign off,please pravide e-mail address:
Owner Name:
Owner Address: Owner Tel.No.: I
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RESIDENTIAL AND/OR COMMERCIAL BUILDING I
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 location;
(2.) Floor plan labeling ALL rooms within building
(all existing and proposed) — ,
Note:F[oor p[ans not required for decks,sheds, windows, roofing;
(3.) If necessary, Title 5 application signed by licensed installer j
with fee.
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REVIEWED BY: � DATE: �� � �
PLEASE NOTE �
COMMENTS/CONDITIONS:
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