HomeMy WebLinkAbout2011 Sep 15 - Sign Off Transmittal Sheet - Use and Occupancy i .
oF�a,,k,� TOWN OF YARMOUTH
o= ' `-y HEALTH DEPARTMENT
�\��^V�1x PERMIT APPLICATION SIGN OFF TRANSMTTTAL SHEET
i To be completed by Applicant:
I Building Site Location: , -�j Q� /yJ�J(�[S'��/�/ Y�¢����¢
Proposed Improvement: ��/F'(4/ _�"����
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iAPPlicant:���/L�='�i,t�,r �cc,c'�7`Z�if1[iF� Tel. No.���F�T6?
' Address: �'g/� ���i��y�,���� DateFiled: //'s/.�/
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*'Ifyou would like e-mail notification ofsign off,please provide e-mail address:
Owner Name:, . ��f/� � //, c. �QC.��
Owner Address:� (}`�� ����� ���M,�wner Tel. No.:(,�7���/>7�
RESIDENTIAL AND/OR COMNIERCIAL BUILDING
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, roofzng;
(3.) If necessary, Title 5 applicaHon signed by licensed iostaller
with fee.
REVIEWED BY: ���„f��n�� DATE: 9� �"�j
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PLEASE NOTE
COMMENTS/CONDITIONS:
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