HomeMy WebLinkAbout2008 Jan 09 - Sign Off Transmittal Shee, Floor Plans . .<._....o--,.,�.,�,_.,..,�.,.r,..... _..._-.,�.-,.-,_...-_. . .. �-++.�•�++�.w'-^-.--<- �,..-.-.+�...�^.,,"' :.a__�.-•�' _ --�'-�,....._�-- _.,.... . .
°��Y�� TOWN OF YARMOUTH �
o$ e HEALTH DEPARTMENT
F�j,""<;„,:3'�,�
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: S � � �t a � W �y�'v n o„� � h",a C'a(���ap No.: L.ot No.:
Proposed Improvement:
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�PPlicant: ;�U rt �'��v� � S�� � � r � �v �..� ��S �77/ a � 8 `/��"
� Tel. No.:
Address: 5�� `-' �`1 � � W � � �� Mc u I � }�t � - �' � � � � Date Filed: � �� /� �
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**Ifybu would like e-mail notrftca6on ofsrgn off,please provide e-mai!address:
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Owner Name: ��('n�/ C� VG�GQ
' Owner Address: Owner Tel. No.:
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 s6owing e�sting buildings, water line location,
and septic system locafion;
(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
with fee.
REVIEWED BY: DATE: I { � V
PLEASE NOTE
COMIviENTS/CONDTl'IONS: �
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File name:Untitied Your note:~
Date:1 /5/2008
Scale:Print to fit paper size
Dimension:60' 1" x 230411
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