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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 ' _...._....._......._._.........._�_................._._.............__........._.........._............_........................._................................._............................................................................................................................_................._._...................... 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 � ee e oeeee o � e a - e e � ve� � o m � � o o � ;e $ I e �" � �'n'w vi n a" .. �o' m w .. e o�e" �e � t,� r y : �n m N N :;�= � ee m '�i' O :b rn ; � v � h �V � N � ':C �+�+99 d \ � i �. '.�.�.y V� V O w O v w 00 � � � iC' y m . . � �NH�J U� � V � .y f.� ' V ' ` 3 �t+i.i � a�p e � � ''4 e epy 4 m ^ � C � .. �` . > e ?. =%B� `g � `� a`�+ muu w .°3 =.U�� oU Py ''� � m [� � `� c+ Q oo� . �e ��' a.�,.�r a 3�t�.exrv.,ee � .7 eeee � m a '�� ?�e' �'� o.ee Q . 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