HomeMy WebLinkAbout2015 May 19 - Sign Off Transmittal Sheet - Storage Building, _ �_�..�.,,�...
�f="qR TOWN OF YARMOUTH
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3 c HEALTH DEPARTMENT
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�''•�•``� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant.•
Building Site Location: qZ0 �9 rPcc� -L s�GnG� � � , [�. �UrMcwl�h. 6y�
Proposed Improvement: C-�r s�� �y �X LO � S � �u, ��t'+ /�
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Applicant: �� r rw1 r,� Y�-�� (k � / c` �� - �� —
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Address: � `�`7 f��lP�y� CQ�� n �cd� �-/p,q w,c� �. t�-/fF Date Filed: S -/ S - / S
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*'Ifyou would like e-mail notiftcation ofsign off,please provide e-mail address:
Owner Name: /yG'r-L/� �--� C'/t�
Owner Address: Owner Tel.No.:
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RESIDENTIAL`- '/ COMMERCIALBUII,DING
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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, roofueg;
(3.) If necessary, Title 5 application signed by licensed installer '
with fee. '
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REVIEWED BY: � DATE: �/�I/I S
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PLEASE NOTE
COMMENTS/CONDITIONS:
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