HomeMy WebLinkAbout2022 - Withdrawn - sign off transmittal \k.,1\41akUO'n.1
7a;t.'Y "4, TOWN OF YARMOUTH
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PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: ?6, /co A _00--/ 7 4 /77/ O?. 7_$'
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ProposedImprovement: •
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Applicant7G0 eittgvat4 14 /c,/evl A - ..r el. .: `77Y-q cti-" Yyg
Address: 6K Vci-iii-, G Z ( rIvt / /1/1 0.2G>Z__- Date Filed: //c4a-a_
**If you would like e-mail notification of sign off please provide e-mail address: C/av• ' Ofu LL;„c,.14.7-e....iiiVieriAZ4414
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Owner Name: l o,'cc1 /Verb✓r ✓C2 t.
Owner Address: 6 Y flov dor-rt Zvi Owner Tel. No .5C1 ?2 —7--rU6
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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;
JAN `i 4 2022 (2.) Floor plan labeling ALL rooms within building
(all existing and proposed) —
HEALTH DEPT, 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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