HomeMy WebLinkAbout2015 Jul 01 - Sign Off Transmittal Sheet - Use & Occupancy - Dog Training Facility � _.�.. � :� _ ,���.�. . 1
of��e TOWN OF YARMOUTH
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�2 �� HEALTH DEPARTMENT
� ^•<w•O $ PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: ��J h�l(r�r��J 5 C QG K1Z�-� 2��
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Proposed Improvement: �oG `�A W 1 N G �'�c � l,i � i' � c� C G IJ K!JJ�-y �c r n�, (
Applicant: I" ���vV �/V l-1 �'T� Tel.No.:`+�`l- �� � ' ���3
Address: S 3 S i���11J 5 C QDW E�L (Z �. Date Filed: / S
•'I,fyou would like e-mail notification ofsign off,please provide e-mail address:
Owner Name: lj'1}JJR`f L D�GN L I�V
Owner Address: �.O �(�l S"� 1 `li�LMv� (� P�� Owner Tel. No.: SO b�'7 3 7 . i��c�
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RESIDENTIAL AND/OR COMNIERCIAL BUII.DING
HEALTI-I 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 ezisting buildings,water line location,
and septic system location;
(2.) Floor plan labeling ALL rooms wit6in building
(all ezisting and proposed) —
Note:Floor plans not required for decks,sheds, windows,roofing;
(3.) If necessary, Title 5 application signed by licensed installer
witL fee.
REVIEWED BY: DATE: � / �S
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PLEASE NOTE
COMMENTS/CONDITIONS:
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