HomeMy WebLinkAbout2015 May 26 - Sign Off Transmittal Sheet - Extend Patio � �OF�'qR,� TOWN OF YARMOUTH
�� • -��� HEALTH DEPARTMENT
Y '�•�••`" � pERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: �� CL� a Z� �d , �/ _——
Proposed Improvement: C�C�e r�� �x , ; h / '�� 4 G o t, � � �f Vt � .Oe� ��o Jr
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Applicant: ���t h �ai�v f� Tel. No.: ��'i�77�� �����
Address: Z C�_�� /< <, +-�c�s � � i c Lc. /�t�✓�,n h�� Date Filed: -s�2 G ��S
•slfymr would like e-mail notifrcntion ofsign o�J;please prwide e-mai!address:
Owner Name:�_, - a l-e, i/
Owner Address: � �in c trc. � ' �l Owner Tel.No.: �G S 'Z ��'J � 7 Z /Pi
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RESIDENTIAL AND/OR COMhIERCIAL BUII.,DING ! !��
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 ezisting and proposed) —
Note: or plans not required for decks,sheds, windows, roofang;
(3.) If n� sary, Title 5 �pplication signed by licensed installer
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REVIEWED BY: �1/�/�� DATE: ����
PLEASE NOTE
CONIlvfENTS/CONDTI'IONS: / /� ./ �/ C, �
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