HomeMy WebLinkAboutBLD-21-6569 of Yq TOWN OF YARMOUTH �3 L Z/ -v6
c HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant: �q
Building Site Location: PtAe. I AItP uTr-4 -Po2T t/r
Proposed Imp ovement: PJ-e-� iei�CJ (A)IA � /�l'N Iwo
Lt✓ fS C h/Lo UM �
Applicant: DV i tfYt 21 Lh Tel. No.:6'06—7/3 106Ci
Address: e iNf S (IVD ILCf/S"ef b l6 a 2- Date Filed-
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*Ifyou would likee e-mail notification of sign off please provide e-mail address:
Owner Name: !J k 1 [1 Q-1 ICO _
Owner Address:e T'clU G 'l` 2QCe &, Owner Tel.No.: SQ8"1/3-7(1&
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: 1/
PLEASE NOTE
COMMENTS/CONDITIONS:
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