HomeMy WebLinkAbout2014 Aug 18 - Sign Off Transmittal Sheet, Plan ,A. .. . ,..� _...... ..-� ._ ._. _. ..��.w.� _. , . . ,.._.�... , �.-:�:w-'1
of.—'_'r--� TOWN OF YARMOUTH
s'r y'`. `�c
!� HEALTH DEPARTMENT
o �.,
� 4'����•d � PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: �3 �U INSJRIei RQ41� , �/�Q(110UT� , (YlA , �d(�{
Proposed�'provement: J� � AT m Tp y � �fN �m
G�'(�'�G1Rpi Ce�t,wC, - Su.�� �a2 Ptrc(�crl�C �a�1.iNGS s�a,a,wa..� Po.,� untlwaY
Applicant: �W NP�r , Tel. No.:
Address: Date Filed: G /�/��
li •*lfyau would like e-marl nodfication ofsrgn off,please prwide e-mar/address:
` OwnerName: �fPi�iQ �/k��,
OwnerAddress: �� l.Ui�J�rtY2, (�.a4L1 , ��A�Ltltiot)Til, (n�l OwnerTel.No.: 'J��� �v a5s1
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RESIDENTIAL AND/OR CONIl�I�RCIAL BUILDING
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:
(i.) Site Plan showing existing buildings, water line location,
and septic system location;
(2.) Floor plan labeling ALL rooms within building
(all ezisting and proposed) —
Note:F[oor plans not required for decks,sheds, windows, roofang;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
.........................�........�...�........��...............................................
REVIEWED BY: DATE: Ci .
PLEASE NOTE
COMMENTS/CONDITIONS:
1
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