HomeMy WebLinkAbout2022 - Withdrawn Sign off Transmittal - New Deck 0N-.-Y44.,� TOWN OF YARMOUTH
tr,; HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL : EET
To he completed by Applicant.
Building Site Location: ,ti✓'- ,�i-t/,1..—� i 4,16
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Proposed Improvement: r & 11/ I) e e / 1 rep nA e lY
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Applicant 9-��� _ 1,,...
Tel. No.: y6
Address: /-4-_ I'/ ial.e ..A.j p ..-P , r...4 Date Filed:
**Ifyou would like e-mail notification of sign off please provide e ail address:
Owner Name:
Owner Address: \LJs) -04)d r o\ Owner Tel. No.:
RESIDENT ' L AND/OR COMMERCIAL BUILDING
HEALTH DEPARTMENT: Dete , nes Compliance to State and Town Regulations; i.e., Requirements
For -ptage Disposal and other Public Health Activities.
' ease submit three (3) copies of plans, to include:
(1.) Site Plan showing existing buildings, water line location,
G Z--10 ZD and septic system location;
JUN 2 3 2021
(2.) Floor plan labeling ALL rooms within building
(all existing and proposed) —
HEALTH DE' 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:
PLEASE NOTE
COMMENTS/CONDITIONS:
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