HomeMy WebLinkAbout2015 Jan 16 - Sign Off Transmittal Sheet, Floor Plans - Build 4 BR Dwelling 2oF�R,�o TOWN OF YARMOUTH
� - � HEALTH DEPARTMENT
� '^•_••`' x PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Buiiding Site Location: � �t-��L� � w� ��'u�
ProposedImprovement: �ON��� NCv� 5lNG�g F/4�'^� �� DW�Z�.1NG
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Applicant: � t-4-or.ws �N�t-L� Te1.No.: SGfC- a9y'`?SFss
Address: I Z� V���D�e �• Sa��t+s3v���h, �✓k D I7��- Date Filed: ('1 S-- �r
'�Ifyou would like e-mar[notrficatron of sign on;please prmide e-mail address: 1 4 iN�-1r4��[',-/�/�p9 f C.-���"�
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Owner Name: M� c t-fft t-c. �a�teYh M-N
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Owner Address: S �wt'��il � �� ���`^�� Owner Tel.No.: 7 �y�4�/-a 3�l
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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 existing buildings,water line location,
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.
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REVIEWED BY:��1/�/.//� DATE: /- /6 �
PLEASE NOTE
COMMENTS/CONDITI NS• ,
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