HomeMy WebLinkAbout2022 Sign off Transmittal - Interior Remodel TOWN OF.YARMOUTH
S HEALTII DEPARTMENT
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PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
7o he completed hp.4pplicant
Building Site Location: 3 13 re t,+1,6A,Li Dr..
Proposed Improvement: e A cc orn
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Applicant: ' —11. .irz,1 1-1-y p.h Tel. No.. 6,1.L -,i 3-c/4
Address: f.reivk LuCLt l Dc. Date Filed: L' (,/2-2.-
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**If would like e-mail notification of sign off please provide e-mail address. O17 6 Q 4 NA i I.Coiti
Owner Name: J t(14-A) >J(7 `/ EA)
Owner Address: 3 ) r 11-W o Dr. yp<rm o&, -f G, Owner Tel. No.: l4- •S'( 3 - C/N6
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,
RECEIVED and septic system location;
ASR06 � � (2.) Floor plan labeling ALL rooms within building
(all existing and proposed)—
HEALTH DEPTNote:Floor plans not required for decks,sheds, windows, roofing;
(3.) If necessary,Title 5 application signed by licensed installer
with fee.
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REVIEWED BY: i DATE:
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