HomeMy WebLinkAbout2022 Sign off Transmittal - Flood Vents TOWN OF YARMOUTH
HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
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To be completed by Applicant:5
Building Site Location: Se° 4),c. W rig Cif 0.-// e C. A U
Proposed Improvement: ChoS E? f L,, w e1J 'p r 1cX is fi`
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Applicant: �,t. Aiec/ 8= 6 q
PP G t ��+ S Tel. No.: 4 `
Address: • /- ,-//' �`�-C Date Filed: #41/ 7/2 1---
**/fyou would like e-mail notification of sign off please provide e-mail
address:
Owner Name: 4pi k) A -r-A. 9h .A.04/
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Owner Address:/ d1t 11- tto0-7 (Pi+ / T/ Owner Tel. No. Y d "7 fd 3
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:
)17 1Z
PLEASE NOTE
COMMENTS/CONDITIONS:
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