HomeMy WebLinkAbout2022 Sign off Transmittal - Deck of YAC TOWN OF YARMOUTH
HEALTH DEPARTMENT
'4'040,0:5 PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: aZDC V e L
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Proposed Improvement: (l' 17ec.-k
Applicant: 1 Tel. No.: 9 71 27O O8g3
Address: 11 �vv.-.-re �--r ���c�O--� .Alk- 02-c-'1:5— Date Filed:
**If you would like e-mail notification of sign off,please provide e-mail address: Co-c- 1 i vv_k �3 24:�\ Ct t. 4300,k,
Owner Name: w.0. 1.42-C L
Owner Address: ti mak,,.,.,+< 'cc c c / A' evzc-ri Owner Tel. No.: `dg- l7O as--q3
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
• h fee.
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REVIEWED BY: DATE:
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