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HomeMy WebLinkAbout2022 Sign Off Transmittal oVqk TOWN OF YARMOUTH s '�c HEALTH DEPARTMENT PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: Building Site Location: L karjCef ("jaw) weal- C atcr-V , ,1Y7 ) O (p--,3 Proposed Improvement: Sci Ljsa,r-- lc)-0/(ti 1tov / )Qu Cd ve _ -5( . 0#+#f tBaliNcOOTY1 7—nu- ) pool }n.bL , c�Om n° a re r . S 1 Applicant: (Y)1 ch Ct El - n Pts?reg./M Q ri a PCQ r(liTel. No.: 1 N -1-:)-a -324 Address: t-} )(cu CQeS ft)a.,t. W-PSC-)- (JCjrryryt4 non- Date Filed: L"/ I q /a-0 **If you would like e-mail notification of sign off,please provide e-mail address: m *'Z C/-�6 Owner Name: Y ) I On a E. I nal-an P r Owner Address: P Ct.. _ ' • , !r„, •wner Tel.No.:1 -J 422- 122- 1 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: igi LEDIECD (1.) Site Plan showing existing buildings, water line location, SPR 202? and septic system location; (2.) Floor plan labeling ALL rooms within building HEALTH DEPT. (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: 5 /a—). L . PLEASE NOTE COMMENTS/CONDITIONS I SA-V2ty N`T l� v S�� S c` 13eiv-0 c i 1,6 1 QE:;©&u� ,..1 ARR 1 2022 1 • HEAL77-r DEP7; j t ,,1 Cooc h i 1/4...,...i?3_i-r,.:.,-,..,,,.-_,, 1, .1 I i E- o1\ 0 r Cil° 0 I P irlR, "- 1 'r _ ® 1_. ,.:*'-----'©i ,, o °c f/ _ _ l Ik ) ,l + 14--�n Iv • 1 f I 1 clsI S d z 0 0 0 N VD e tVtV 1 N liN O CI 2-e O C �> :i illri Z -; i ' .r _ I 11 ' iT�.os t x N o v I ,1 n ,-\ -r_rL--`. ci��? IF ' I $ o ee '--.; m D0 �` oz tel� ` "-'t fes'( L! ,i' , I A '.Iu! Y V o -a Vii.- ° ri ,i m- ' SS. . y - O tie V x �I LI ' �� 1 m l r _ 1 m w i c.--) �{ , :mac �. fr, . 11 r- . m orC�x /� f108a t� ice"—s--��s s__-_.__5 G'� \/ Lr 1DO .m f m �)r 'Gj N;I�X �OnzVZi �_i 3 J• t. /` `5ry Z0350d ad �.l'tZ 4 oliimo5 Sy 4`� Al 1l��ii _ < -.O OP y U <-af > m z my Nmta o ? '1C1-, TN g t $ 41. 00 /E-,N, 135.00 :_ 11�' .. i�� is�M �4 ada� xsno • kJ- it1 ol_ o r )-'. w -- ill i�emDm; _� aO. � N - Z i$ o$ 2 -- - Pg.; sig g - 14 g 8 a O ill m G3G�L�uC7u y mg$ _ya m Ga Sg b ^ ; i� D 192022 .g ... �it mmg . r o - m a:o ? 1\ APR = ��-= mems .o o j .; E mj::; =HEALTHDEPTx0g ' •R 'E, i . N m L §=.' >12 1 R r '- i 0 ti, r lam H crso 8 y N 0 T$2V- $ Ain DDSLi SS o N ON^r D N r iX3'PP Or." XXZ Z 222 Z0 DSOaA N D �• CHER t11;if nV! 10-m.2.-,_),,,,g-4-1 m�pIo00 O 0SDN {N/1 1'1 O 00 OsAy1m�,y-IN y00j /Z,, \O9,, A c ZD 220M ON YJ Nin;F+ x V/ �_ ^ y ' O D c 7 t l+� 1 �� Y 00 00 gWIZ Z11 ; S i .n41.8' ^ Z= y Q \ A; A D CD K2 .A.-..,ZP 3 -1'2 A V . \\ a 0 t) n ) v •< 02 O O Kqg D `/�� pa b - ^D in m o �"-1 a 1 aA-� $ D s ]3 n o m fim 0000000 z my$ gi 1 o'e $$ o o m D s No Z g `l= - I�Wi q Cb n o Sm N 3 rti i% ii Pe 9-ee iia O- Z T gm X -,.___i01- `�`JO�� w< a'T.LL n —4 l m oik :u 'ea) a St K- / tx gall9