HomeMy WebLinkAbout2022 Sign off Transmittal - Deck r
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TOWN OF YARMOUTH
. HEALTH DEPARTMENT
S 44,4*.i;C"
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant:
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Building Site Location: .5—I' o .,.,-r, ,. c.i _'I_ L . (L /„r1,,.. -, / 4 ..r ii,
Proposed Improvement: U .17 y -= , , (:'<" s). , >R ko� . / a ( 11."Jr
Applicant: -r:.,,,,,,- 74:4 1 , Tel. No.: 77 Y I, 31 / F.j G
r -2 t, ( Date Filed: ' ' r -�1
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**/fyou would like e-mail notification of sign off please provide e-mail address:
Owner Name:
Owner Address: 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: ?-) l DATE: // /
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