HomeMy WebLinkAbout2022 Amended Health Sign Off - Partial basement finish I
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01 :4;.;:.`4.,\ TOWN OF YARMOUTH
416
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HEALTH DEPARTMENT
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_ 2`'' PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant: /
Building Site Location: ( \/ /V L 5 , ' exA/ait,v ti .
Proposed Improvement: . e' '1,1 (I t41 tiZ 4 I,t4 Q4.1.4,
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Applicant: V /1_0044 t-f-k> Tel. No. 0 7C-7 Lc/7
Address: 1 -1:\--\/ ,/1/ 7 Date Filed: ____ _47a
"/fyou would like e-mail notification of sign off please provide e-mail address:
Owner Name:_ �� . i , -44.E
Owner Address: I �i "� /C� wStIA�T` N Owner Tel. No.: *-
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.
IPlease submit three (3) copies of plans, to include:
MAY 3 .l 2022 (1.) Site Plan showing existing buildings, water line location,
TH DEPT: 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.
S _REVIEWED
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BY: / /, DATE:
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PLEASE NOTE T
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