HomeMy WebLinkAbout2022 Sign Off Transmittal - Pump House � TOWN OF YARMOUTH
°; HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
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To be completed by Applicant:
Building Site Location: 57.0 fr-2:47r7 5 1
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Proposed Improvement: v 1 !>/ 4144 el /e7ir-i) /0sx /46.,4//z,/ f/vt r,. e---
Applicant: / 7- �. (:). - Tel. No.: sem- 6J 0
Address: -%17 6K( J /�� � -kei4 L Date Filed: (//2/72.,
**If you would like e-mail notification of sign off please provide e-mail address:
Owner Name: \/ay / -U✓r G
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Owner Address: <7 0 146,,'., %/7/fv/Z 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: DATE: 4�
PLEASE NOTE
COMMENTS/CONDITIONS: