HomeMy WebLinkAbout2015 May 26 - Sign Off Transmittal Sheet - 2 Car Garage �oF�'9k,� TOWN OF YARMOUTH
• �� HEALTH DEPARTMENT -
� ''� a••� s PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: 7 7 ���/ �d • 1�✓. y/I��+�+ a ✓ � �''�/� 0161>
Froposed Improvement: c e �.,- f �e � .��
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Applicant:�����i f7. r o i cT Tel.No.:�o�fu9 fo UJ �
Address: `� / f��,,., ���(� /L . irr/l�/ �a<t /I1�¢. Date Filed: ��j 6 i i
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'slfyou would lrke e-marl notification ofsrgn ojj;please provide e-mail address:
OwnerNazne: V'/� � u /�!L vH/�(/,
Owner Address: 7 7�/ -b t ��1 �o/f� �^'. X./�..-�o�}�wner Tel.No.:
RESIDENTIAL AND/OR COMMERCIAL BUILDING
HEALTH DEPARTMENT: Deteimines 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 plao labeling ALI, rooms within building
(all existing and proposed) —
l�7ote:Floor ptans not required for decks,sheds, wvedows,roofing;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
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REVIEWED BY: DATE: ��' �
PLEASE NOTE
COMIvv1ENTS/CONDITIONS:
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