HomeMy WebLinkAbout2015 May 18 - Sign Off Transmittal Sheet - Demo ot-�a'?,� TOWN OF YARMOUTH
o� " `\`y HEALTH DEPARTMENT
��'"_^`% � PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location:_ /� (O � �� ���� Sf ��1�( �}.�
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Proposed Improvement ��Q M o I j�� o h d� l Yr JT/ h t �u i �d i n c
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Applicant: CAPizZi /�umt =rr��y/�rytli(-r� Z{/� Te1. No.: ���Gy�O�Lby
Address: i (� 4� �1��aH'aWN R p �v1��1-� Ilrq o �,G 3 S� Date Filed:
'•Ifyou would like e-mail norification ofsign off,please prwide e-mar!address: �/ /�
Owner Name:_�N G �j 0$ �
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Owner Address: p a B uX �1 3 �u n D E elc� IV 12 77� Owner Tel.No.: `11 y- S',t 3� �.2 4 �
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RESIDENTIAL AND/OR COMNIERCIAL BUII.,DING �
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements
�7 For Septage Disposal and other Public Health Activities.
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��h�►o u h l� Please submit three (3) copies of plans, to include:
N U� � (1.) Site Plan showing existing buildings, water line location,
7q Te � ' i)1/'� and septic system location;
(2.) Floor plan labeling ALL rooms within building
(all 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: DATE: l�' I �
PLEASE NOTE
COMMENTS/CONDITION :
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