HomeMy WebLinkAbout2014 Aug 04 - Sign Off Transmittal Sheet, Plan - New 3 BR Home with Attached Garage ,, � _ �.
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oF.-'_Y-_�i , - �`";TOWN OF YARMOUTH ..
'� � -'�° '` `•HEALTH DEPARTMENT
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'� _ •' PERM�,APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant.
Buildirig Site Location:� � a /6Qr' �•cvL� (�/�P G/MU�
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Proposed Improvement: � 4�- ' � -/'/,
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Applicant: )�V\r.��hU(� ��Y���Cc Te1.No.:_Q� �U�l �/a(e
Address: t (` � 1 ��,t WI 7 Date Filed: ' 3 ',./ `
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•'Ifyou Would like e-mail noditcation of sign o ,�lease prmide e-ma
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OwnerName: ✓1 ✓ tt S Qt/I 1"l� l�P
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Owner Add�ss:�nC� �Oc�d�� �� ��S � O Tel.No.:��f `�D 4 7h 7�s
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RESIDENTIAL AND/OR CONIMERCIAL BUILDING
HEAL�EP����IVT� etermines Compliance to State and Town�ah�4�e.�eq rements
�� or Sep Di sa1 and other P.pblic Health Activities. ^"�-
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Please submit three (3) cepies �plans,to include: '
(1.) Site Plan showing ezisting buildings,�vater line locatioe,
and septic system location; *�
(2.) Floor plan labeling ALL rooms within 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 <
with fee.
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REVIEWED BY: �� �JC.QO/X��P/ . DATE: �- g /�
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