HomeMy WebLinkAbout2022 - Sign of Transmittal - New Deck of''rA.R TOWN OF YARMOUTH
FEB 'I
HEALTH DEPARTMENT 0 202
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HEALTH DEPT
''r,c„E`° PERMIT APPLICATION SIGN OFF TRANSMITTAL SH 'P;'1'
To be completed by Applicant:
Building Site Location: (o'7 C,9e7AVA) GvfZ/6//7 f2.�
Proposed Improvement: R DTA/770%i I O 1( ( 3
Applicant: ,S,z?v1j 2)44_00 C 1/5 7-0/17$ L-L.L Tel. No.: 307 -(�99 5 /1
Address: d S 9 GnEextT 'I 97 .T 71/N/S Date Filed: ,V174
**Ifyou would like e-mail notification of sign off please provide e-mail address: (,5 -F.its ( SSjj'DA LL4'CUSanS•
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Owner Name: 5G�.rn�.�s UAW(-L
Owner Address: CCt*J k.)43 n 4 4 . Owner Tel. No.:
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 existing and proposed) —
Note:Floor plans not required for decks,sheds, windows, roofing;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
REVIEWED BY: irr.)1741.,'--...'? DATE: A. Z
PLEASE NOTE
COMMENTS/CONDITIONS:
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