HomeMy WebLinkAbout2014 Oct 09 - Sign Off Transmittal Sheet - Ceiling .�-�-�,-�.-�-��..,� __�_.�-,..,_ ��:.T._._.,�..e__�R_ _ _.__ _ �_.._�_ _..�__-_ � __ ._.
�oF;R�,yQ TOWN L1F YARMOUTH
�y � HEALTH DEPARTMENT
� ''«_•'`��� PERMIT APPLICATION SIGN OFF TRANSTVIITTAL SHEET
Ta be completed by Applzcant: �bv'C� �
Building Site Locadon: � $� �,tyti��j� . W� ��j YnGU�y .
Pra ed vemeirt: � �
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Applicant:_,��yZC} l'�ri�4K�c��nr. .�nC. Te2.No.: Zl�{2�
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Adciress: �� ��ZC„ � �� `"K�T�i 1G�._� 1� Date Filed: rp-0'�i— i�l
**Ij'you would like e-marl nottfication ofsrgn off,p/ease provide e-mar/address:
OwnerName: �c�Ue �-l�".`'�,`(�tYY1GUYl�� �
Owner Address:_ �g3 �Gi Vi �J� . �E'.S� � �M1. Owner Tel.No.: `�jt-���� �((�(a
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RESIDENTIAI.AND/OR COMI4IERCIAL BUILDING
HEAI,TH DEPARTMENT: Deternvnes Crrmpliance to State and Town Regutatians; i.e., Requirements
For Septage Disposat and othez Public Health Activities.
Please snbmit three{3} copies af plans,to include:
(1.) Site Plan showing existing buildings,water line location,
, and septic syst�m location;
(2.) Floor glan labeting ALL rooms within building
(alI eaisting and proposed)—
Note:Ffaor ptalrs not required for decks,sheds, windows, roofing;
(3.) If necessary,Title 5 application signed by licensed installer
with fee.
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REVIEWED BY:� �^DATE: /d��j�/ �"f`
PLEASE NUTE
COMMENTSlCONDITIONS: