HomeMy WebLinkAbout2022 Sign off Transmittal - Replace existing deck - enlarge .,t.l'rtk TOWN OF YARMOUTH
tt� °: HEALTH DEPARTMENT AUL13 ?02Z
� \ ��� HEALTH DEPT,
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant:
Building Site Location: Co pone„- Or, ,_yarrnarth -V
Proposed Improvement: r-e\A e�c,S?c, C \=,ice t - 4ei 1t� -a cb e *u jst
r-eR\cxck. 6,ecki, c -eo./y r r -m ,61 Pet-ex, ' ' ' R-,5
Applicant: 3-amve Pwxt - 3c- Tel. No.: 50a-a15- ---14.40
Address: L\ V-e_\-- .cod, Grp \- c cl, Mc4 Date Filed: -7- ) - Z Z-
**If you would like e-mail notification of sign off please provide e-mail address:
Owner Name: c ,1 A- 1kcieN CA\VA'yir
Owner Address: is \)(1u0Arc. mac-. Owner Tel. No.: 5CEs--coLkI-1QeQo5
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: gliDATE: 7 --,),C -22--
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22- '/ PLEASE NOTE
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