HomeMy WebLinkAbout2012 Nov 28 - Sign Off Transmittal Sheet - Use & Occupancy ______ _ _ .. _
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.oF{aR,y TOWN OF YARMOUTH ti�1 � �
3� � °=� HEALTH DEPARTMENT '°:,q
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���=•>��� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET �,
To be completed by Applicant:
Building Site Location: �, \ ( � T�,I.( � J� � �.�Qri I t��(�'�Y l � � I� �o��p��j
ProposedImprovement �� VC' �
Applicant��` (� I Y C,�1 � / Tel. N ��6���—O; � U�
Addres$��l ��� �- �� .`Cl.0 f�'�� 1���(D��Date Filed: � Q � a
"/fyou would like e-mail notrfication ofsign off,pJease provide e-mail address: '
Owner Name:�(�� 1� ��l�d1i rl ,
OwnerAddres��� ��� 1�C� •�,��� 1 I��`^ -OwnerTeLNoy�,� � " /U�(J—���� �I
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RESIDENTIAL AND/OR CONIlIIERCIAL BUILDING
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements '
For Septage Disposal and other Public Health Activities. �
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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, wdndows, roofing; �
(3.) If necessary, Title 5 application signed by licensed installer '
with fee. �
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REVIEWED BY: .. � DATE: � �'�-Cl �� Z= I
PLEASE NOTE
COMME�N/ TS/ ONDITIONS: "7�"�
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