HomeMy WebLinkAbout2012 Nov 28 - Sign Off Transmittal Sheet - Use & Occupancy _ . . ___ _ � __ �__
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oF�ae,y TOWN OF YARMOUTH
_ �° HEALTH DEPARTMENT
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����`° � PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be compdeted by Applicant:
Building Site Location: �� - � ���`c `,�-}-�( 1 g •��j r�l'� ��
Proposed Improvemen • 1 U � �� � (J�� � �J
Applica��,( '� � ��(��l , Tel. No�' �"��(,�
Addres�(O� o? j,{�'1�C"U.IY 1 J •`1Q�1 1 C�l� C I�� 1'�DateFiled: f (� v�
`*/fyou would like e-mai!notrfrcation ofsign oJj,please provrde e-mail address:
Owner Name�(/� ��C� � I� �.E' �
Owner Address�/) �(�//�r C�� - �v��(,(�� � ��Owner Tel. No : ' — �
RESIDENTIAL AND/OR COMMERCIAL BUILDING I
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HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements
For Septage Disposal and other Public Health Activities. I
Please submit three (3) copies of plans, to include: ,
(1.) Site Plan showing existing buildings, water line location, '
and septir system location; �
(2.) Floor plan labeling ALL rooms within building �
(all existing and proposed) —
Note:Floor plans not required for decks,sheds, windows, roofing;
(3.) If necessary, Title 5 application signed by licensed installer i
with fee.
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REVIEWED BY: , DATE: � �/J� u�� �
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PLEASE NOTE !
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