HomeMy WebLinkAbout2015 Jun 17 - Sign Off Transmittal Sheet - Storage Shed� _� �. .� - _
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roF�q�e,� TOWN OF YARMOUTH
� �� AEALTH DEPARTMENT
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Y ^• �•� x PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET '
To be completed by Applicant: 1,.-✓
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Building Site Location: �U�, �� � - � �oc�� �So�s l�'CT�'«
Proposed Improvement: �oR-AGE �rig� _ �p� �( �A� i,�G �Cic � � T� �
Applicant: }�-�6R--t �r.�S I�� Tel.No.: 5�,776.(00 Z�"
Address: P•� d�` �3� � v�CND�i� t9Z(o4sf Date Filed: `' (�'�s
"Ifyou wou/d like e-mail nodfication ofsign off,please provide e-mai!address: 1YI��G✓a1'� SO f�S/�l G��A.Ir}!L� �-C.'L�
Owner Name: liev�n+S �o��c� I
Owner Address: Z�{� �k l+� CJi 11"A�t�c�. Owner Te1. No.: `J�t5. Z`�$. 75�
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RESIDENTIAL AND/OR COMMEIiCIAL BUIL.DING ,
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulafions; i.e.,Requirements
For Septage Disposal and other Public Health Activities.
Please submit three (3) eopies of plans, to inclade: �
(1.) Site Plan showing ezisting buitdings,waber line location, ,!,
and septic system Iceation; '
(2.) Floor plan labeling ALL rooms within bniiding '
(all ezis4ing and proposed)— . !
Note:Floar plans not required for decks,sheds, windows,roofueg;
(3.) If necessary, Title 5 application signed by licensed installer ,
with fee. ',
REVIEWED BY: DATE: � '
PLEASE NOTE '
COMNfENTS/CONDITIONS: �- '
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