HomeMy WebLinkAbout2015 May 13 - Sign Off Transmittal Sheet - Above Ground Pool _
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20F�'9k,� TOWN OF YARMOUTH
o�'�`' HEALTH DEPARTMENT
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'�--�°`� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant: ,
Building Site Location: �/ � ��/U� K�LJ �b - �I/"1 F-YK-�/�H" I',I
Proposed Improvexnent: /�/s i'rrvli �� �-�/�,�v/�.J ��7
APplicant: ���VT��N� �D� Tel.No.:�dQ �C� ���LESv
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Address:_ �� ����V� ,�(� S� ��/�`�'vU /'n Date Filed: J /�J? �-�
"'Ifyou would like e-mail notification of sign off,please prrnide e-m 1 address:
Owner Name: "�` ` "� ���/7"!V
Owner Address: �� 1/� �� A/�'Owner Tel.No.: ����'�
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RESIDENTIAL AND/OR COMNIERCIAL 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:
(1.) Site Plan showing ezisting buildings,water line location,
and septic system location;
(2.) Floor plan labeling ALL rooms within building
(all eaisting and proposed) —
Note:Floor plans 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: ���5
PLEASE NOTE
COMMENTS/CONDITIONS: