HomeMy WebLinkAbout2022 Sign off Transmittal - Pool TOWN OF YARMOUTH
$14, HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant: f
Building Site Location: S 0 F Fo I K ot,'c
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Proposed Improvement: 1 6 �3�— sLtl` S J
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Applicant: J \� f : 5 it T Tel. No.: V13 2-CS /y '
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Address: S6, S O F F0)1 c ct J c Date Filed:
**/fyou would like e-mail notification of sign off,please provide e-mail address: )ceV- E.c.5 j J�g" Xi')7 60
Owner Name: U .'`'t w r' S
Owner Address:
GG S u Fa'1 K C Owner Tel. No.: Liu acs' lL43g
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;
MAY 2 3 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: I DATE: r G
PLEASE NOTE
COMMENTS/CONDITIONS: