HomeMy WebLinkAbout2022 Sign off Transmittal - Replacing walls/windows in mud room p= R, TOWN OF YARMOUTH
HEALTH DEPARTMENT
6 PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:.
Building Site Location: O�, ? Az A C�.. LAK •
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Prop ed Improvement: b.,' ,,• • 14 �t I 1�.� (/c� I t k. r UU a 11 S
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Applicant: .J Z NN l 12- L #\ Tel. No:: Sii=±-7/SZ7 /
Address: a (AP72
/'"`Z/� C.�f� l..y�ILS � Date Filedi2 o,
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**If you would like e-mail notification of sign off, provide e-mail address: tiny N n( rl P7 120/
Owner Name: �/1l10 l VCR WAt (.-A C /9/flt2 L - Cd/T
Owner Address: ( AZ A (. 2' A (Ahs E_ Owner Tel. No.: WS7/5"Ng,
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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: ! 7 DATE: / ^
PLEASE NOTE
COMMENTS/CONDITIONS:
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