HomeMy WebLinkAbout2015 May 15 - Sign Off Transmittal Sheet - Shed _ ______ _ .__
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�;o4�a�,s, �:" TOWN OF YARMOUTH
4 ° HEALTH DEPARTMENT
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r '��,<..��'� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: �� ��'� Iy t`��- �V�J� y�lrm��/� �� r ��
Proposed Improvement:�
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Applicant: (��r�� � Wbl l�P�\/ Tel.No.: ��g"� g / � 7�7 /
Address: I Ol �J�`'�'1�'�I 1�!!L„ �t/ Y Q Y�►'{'1U(/'�l� � m � Date Filed: � �� / S
•*If you would like e-mail notiftcation ofsign off,please pravide e-mail address: 1��b ba�}(�t� �.vme.a��i�
Owner Name: l/I I r 1 � (�+�r�l
Owner Address: � c/� �Ju�f ��/� � �q r t1?0 U7 i� U!'I�wner TeL No.: �"��_1_7�7�
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RESIDENTIAL AND/OR COMMERCIAL BUILDING
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements
For 3eptage 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 existing and proposed)—
Note:Floor p[ans not required for decks,sheds, windows, roofang;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
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REVIEWED BY: DATE: S�/I �I/� T^
PLEASE NOTE
COMMENTS/CONDITIONS:
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