HomeMy WebLinkAbout2009 Mar 31 - Sign Off Transmittal Sheet - Garage Addition� ,._...�.,�x.,.�._�,,__. .�-.�.��.. �. m-,..._.. .�r�,,..A.�--,,�-..�- �„�.. �. ---�---�-,�
�,�°F�Y`9'4�� TOWN OF YARMOUTH 'I
o y HEALTH DEPARTMENT ,
N�.��3,��" '
�" PEItMIT APPLICATION 3IGN OFF TRANSMITTAL SHEET
;
To be completed by Applicant:
Buildin� Site Location: / � I'h/S��FTo/; ti¢n/E - S• ��R mo�TNMap No.: Lot No.: ,
ProposedImprovement: �/��/9�E' f3�,r�/Tio �U � yuay
APPlicant:_ {��v�t� A. C`i9�v c 5 Tel. No.:S U�- � � a - y 9 G > �
p�s 362 -9�9s
Address: /�' in/SrLE 7'oc L9ivF - S• �9A.4✓ho�Tii' � n. r�- DateFiled:_3��/ o�
*�Ifyou would like e-mail notification ofsign aff,please provide e-mail address:. `
Owner Name:_.vA I/i.0 t�• G.c q ivG v
�
Owner Address: _/� M/S7ct ToF ,c A.v� Owner Tel. No.: fb��76�'`/g�>
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� RFSIDENTIAL AND/OR COMMERCIAL BUII.DING li
T I
HEALTH DEPARTMENT: Detennines Compliance to State and Town Regulations; i.e., Requirements I
For Septage Disposal and other Public Health Activities. ,
Please snbmit four(4) copies of plans, to inclnde: �
(1.) Site Plan showing eaisting buildings, w�ter line location,
and septic system location;
(Z.) Floor plan labe}ing ALL rooms within building
(all ezisting and proposed)—
Node: F7oor plans not r�equired for decks, sheds, windows, r+ao.fiwS;
(3.) If necessary, Title 5 application signed by licensed installer
with fee. �
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REVIEWED BY: DATE:_/3 �/O`�
PLEASE NOTE
COMMENTS/CONDITIONS: