HomeMy WebLinkAbout2015 May 07 - Sign Off Transmittal Sheet, Floor Plan - Demo Deck; Build 3-Season Room _ =of�'+�r,y TOWN OF YARMOUTH
o i `--��y HEALTH DEPARTMENT
� �`'�.�=`�� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be compdeted by Applicant:
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BuildingSiteLocation: // �yPg��� �rf (,(/PS'� 7��OCv1�, �rt
Proposed Improveme/nt: � i � '� � i
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Applicant: �����b� ��{�y �ze� Tel.No.: ��y 8 3 6 s'SOS
Address: �,� �x �i 9 3 � ��`rrz ri c�/! fyT� Date Filed: OS iS
•*Ifyou would lrke e-mail notifrcation ofsign off,please prmide e-mail address:
Owner Name: ��F� �j7 ����
Owner Address: // ���SGf 'r [� /d (�/ES'� yk.2a'/TJ Owner Tel.No.: 5�8 ��/9 ��j�y'
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RESIDENTIAL AND/OR COMhIERCIAL 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 existing buildings, water line location,
and septic system location;
(2.) Floor plan labeling ALL rooms within building
(all exisfing and proposed) — `
Note:Floor plans not requdred for decks,sheds, windows, roofing;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
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REVIEWED BY: � � DATE: S� /S�
PLEASE NOTE
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