HomeMy WebLinkAbout2013 Aug 20 - Sign Off Transmittal Sheet, Floor Plan - Use & Occupancy ,_: , _ .. � �, ,�,e
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o�'Yak TOWN OF YARMOUTH
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HEALTH DEPARTMENT
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•`��^�� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicand:
Building Site Locarion: � z� J\o v"��� l � ) �o �21�1 o v i H �fl �2 6 6 �f
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Proposed Improvement: ��r� r '-' � a Src`.V� " 4y.�S�'� �ti '
�'G� C Q.� Iq w� S �
Applicant: / iA�(CY C� :�RNAL`/ `��CNJ ���n�r�z�st-s �-�Tel.No.: SI��'GI5-3� I '�
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Address: � Sr ORT V�r'ti✓ �'� S'o C�-� ATH/+ M . /�'�Fl �ate Filed: � y� ��3
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*s/fyou would like e-mail notrfication ofsign o„�'please provrde e-mail address:_ 1'1 C 0. h w( y � v e r��a'�'� • "318 t
Owner Name: A�1 C�/ ; �A (f A Ly
Owner Address: / � L i�R T� t'W �� O. ` ��/}TNAM, / �� Owner Tel. No.: � U� r���/O
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RESIDENTIAL AND/OR COMMERCIAL 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 ezisting and proposed) —
�+` Note:Floor plans not required for deelrs,sheds, windows, roofing;
(3.) If necessary, Title 5 application signed by licensed installer
wit6 fee.
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REVIEWED BY: DATE: �� ��—� � ,
PLEASE NOTE
COMMENTS/CONDITIONS:
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