HomeMy WebLinkAbout2009 Mar 19 - Sign Off Transmittal Sheet, Floor PlansTOWN OF YARMOUTH
HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: (p �/!�,%�j,,t/ �' Map No.: Lot No.:
Propospd Improvement:
Applicant: „� jC►�-( Ct P 4W Tel. No.:
**Ifyou would like e-mail notification of sign off, please provide e-mail address:
Owner Name:
Owner Address: r ._� r� 9 �-P 9 r Owner Tel. No.: a� -9 j �/- G g -%
RESIDENTIAL AND/OR COMMERCIAL BUILDING
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements
For Septage Disposal and other Public Health Activities.
Please submit four (4) 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
(ail existing and proposed) —
Note: Floor plans not required for decks, sheds, windows, roofing;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
REVIEWED BY: X, ,; ' DATE:
PLEASE NOTE
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