HomeMy WebLinkAbout2014 Sep 02 - Sign Off Transmittal Sheet, Floor Plans . _ _, _ ,�. . � �_._,.� _ .
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.oF�a.R,y TOWN OF YARMOUTH
3 '-�y HEALTH DEPARTMENT
F "• ••O � PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: � I ��� F-vr�1�
Proposed Improvement: ��c'�t s,. g ( �,,^(��vwS - Sersn c. �.�-� Du-
Applican�d� �n�'k,P/ Tel. No.: S� • Z 3 7.Z`S�
Address: P• u �X 1$5 S. fl• �Ts;r� k/� Date Filed: q 2 1�
"'Ifyou would like e-mail notifrcation ofsign off,please provide e-mail address:�1(viC4t.�/� �'l� A$SOGIik(ES.fD�/�
OwnerName: �J�tFfn� '�" l�//G� �ti��
Owner Address: f' /�7tYJ ,.--1 �' �,/N(zTlj rJ /�C� Owner Tel.No.��45 -33(oC
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RESIDENTIAL AND/OR COMNNIERCIAL BUII,DING
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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 eaisting buildings, water line locafion,
and septic system Iceation;
(2.) Floor plan labeting AI.L rooms within building -
(all ezisting and proposed) —
� Note:Floor p[ans not required jor decks,sheds, windows, roofmg;
(3.) If necessary,Title 5 application signed by licensed installer
with fee.
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REVIEWED BY: � DATE: J-1 -/�
PLEASE NOTE
C Ml���TS/CONDTI'IONS:
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