HomeMy WebLinkAbout2022 Sign off Transmittal - Remove /Replace Deck • ■
„, ''% TOWN OF YARMOUTH
HEALTH DEPARTMENT
'�•`' PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant:
Building Site Location: i C5' r Cr. CI
Proposed Improvement: R t `„ ,��e K,51 ; � eA e c )000 � e c A
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Applicant: l C Y�.„14L�,�, g ,,^ e\,,�, k r\c Tel. No.: }�� - S C , CH 2 r.
Address: \2 +J , C `r�rc Sr tf
, ' 02-01 Date Filed: 'H -
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**/fyou would like e-mail notification of sign off please provide e-mail address:
Owner Name: 4‘..,
Owner Address: 1 � �^ �c f %OrIA - -("")t Owner Tel. No... 41417-3°4
RESIDENTIAL AND/OR COMMERCIAL BUILDING JAN 0 4 2022
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requi=zet ALTH DEPT.
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
with fee.
REVIEWED BY: ,,,2- DATE: /—
PLEASE
NOTE
COMMENTS/CONDITIONS•
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JAN 0 4 2022
HEALTH DEPT
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SCALE: E DRAW Y
DATE:.. ^l REVISED
{ DRAWING NUMBER
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