HomeMy WebLinkAbout2022 Sign off Transmittal - Inground Pool TOWN OF YARMOUTH
HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant:
Building Site Location:
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Proposed Improvement: I -I f [ 1cjVO.f/ 3Uv�t ELL
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Applicant: `v Y� LG 9.,,.,f Bfr, (th,,c( C 4t, Tel. No.: 50`6 3(6
Address: (-7 ( AeitAltc�— �t,r5��`� imA/ On/Lod/0k, Date Filed: �2, rLZ f
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**If you would like e-mail notification of sign off please provide e-mail address: LA 64,a, Q . (. u vi i bP c Vii' e sp• MPT)
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Owner Name: R . i' , 'i y 131 14 r
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Owner Address: 16i, (?Or l `/ Au; I,c,th, Owner Tel. No.: Sd 7 - 6 37i
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
with fee.
REVIEWED BY: DATE: tl o DZ ' r
PLEASE NOTE
COMMENTS/CONDITIONS:
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STRUCTURES SUN THIS PLAN PL*BKft 84, P. 75t LST 8--10
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AS I D CATED.
.: TMILLER.—
,0rr•'%'� 11; f/JOB 8450-oO CLIEN
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10Vtl3 020 203 SETUCKET ROAD
PO BOX 713 SOUTH DENNIS# MA 02660
DAIL" L ND SURVEYOLR FAX. 508-385-8991
� OFF, 508-385-6900. '
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W7LJ ;j TH, MASS
T0� THEBEST
LOT
KNOWLEDGE,AND BELIEFTHE
YARMOU
.
STRUCTURES SUN THIS PLAN PL*BKft 84, P. 75t LST 8--10
THE GROUND '"mom 30HA SEEN LOCATED NDATE SAL_.....
AS I D CATED.
.: TMILLER.—
,0rr•'%'� 11; f/JOB 8450-oO CLIEN
��;.,...� �...� SWC'
10Vtl3 020 203 SETUCKET ROAD
PO BOX 713 SOUTH DENNIS# MA 02660
DAIL" L ND SURVEYOLR FAX. 508-385-8991
� OFF, 508-385-6900. '
C: 1 SV I i. RV V S 8450-00 1 dwg ' 8450 -PPP. i.r'?► V 0 dsL/ fw V if EETV E* �.�I i I W .eL i� L.f i,�.r.� i i A g U
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