HomeMy WebLinkAbout2010 Apr 30 - Sign Off Transmittal Sheet, Floor/Seating Plan r .._.,.� . .� .T..-m.- ,......,'.a+.�-�,.:.. . . .
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,�° � �� TOWN OF YARMOUTH
o y HEALTH DEPARTMENT
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�' PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
Tobe completed byAppdicant: j���f�sip Q �
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Building Site Location: (� � ��/�',��/�� ,�t �/_% Map No.: �Lot No.:
Proposed Improvement: �J 91G11l.h�
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APPlicant: �Jc/N of �Y,���i4� — oLf L:��,rs%GYI Tel. No.: ����- �711- 9D7�
Address: � .�. �✓i;;�laf�,Gn/fl ,(%,�'u 5�;•—•�' Y,:>,_�<�r�r�, .l�lo, ':'�Gf/ DateFiled: >o,o�,,�L -o::y
•�Ifyou would like e-mail reotif:cation ofsign ojj;please prwide e-mai!address:
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OwnerName: �au��/oF �?^,,,ou�f/
Owner Address: ����a ���>t �J 5�;��� y��u�r�T/✓�o, °��y Owner Tel. No.:J���,_�%- =?3/ ��
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RESIDENTIAL AND/OR COD'IIISERCIAL BUILDING
HEALTH DEPARTMENT: Detemvnes Compliance to State and Town Regulations; i.e., Requirements
For Septage Disposal and other Public Health Activities.
Please submit four(4) copies of plans, to include:
(1.) Site Plan showing ezisting buildings, water line lceation,
and septic system location; '
(2.) Floor plan labeling ALL rooms within building '
(atl ezisting and proposed)—
Note: Floor plans not required for decks, sheds, windows, rooftag;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
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REVIEWED BY: DATE:
PLEASE NOTE
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