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HomeMy WebLinkAbout2022 Sign off Transmittal - Shed JZ A TOWN OF YARMOUTH 4* HEALTH DEPARTMENT PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To he completed by Applicant: n ,/ Building Site Location: 3 8 Go.Pfc.t (1 Do re fOcAd (/�'ti /fir,-100—h Proposed Improvement: to x 14 b(/t f d /L5 ok Sited Applicant: ':\, 1C.-0 195.4r12r) 4Q-cSC340A Cin Tel. No.:(SO813E bO23p Address: 3E )D ( :Gl Date Filed: **/f you would like e-mail notification of sign off please provide e-mail address: bl oc'2,4 C.f 7 pc.S.19©g_ Owner Name: \ALp )Q(wJ 64 (-)0e 64.>2 CC/r1-7 Owner Address: 3g Cf -tcu Owner Tel. No.:(Sog) ..6C)-4- 3 0_l 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 J01 U 6 ZOZ2 (all existing and proposed) — Note: Floor plans not required for decks, sheds, windows, roofing; HEALTH DEPT. (3.) If necessary, Title 5 application signed by licensed installer with fee. REVIEWED BY: DATE: ?� ( ( _� PLEASE NOTE COMMENTS/CONDITIONS: 1 r. • !p T 1 100.00' 10, • 1. I_ . X7.25 I .�1 t .:_ , .„ .:"r"-il ' LI-21:-'-;'1.‘.,, _ _ , ...,„ (..- ----23.5'- - -- L___._..._f 1 .DT Box •-a S TEST HOLE #1 ri i ! .\ i E _T. FAILED li E.i_E.V. 99.00 i -� c) I ACHING FIFA.D —� O i- i LOT #379 EXIST. 1000 ,dal. C ,p -0Septic_ Tank I 0 i _ 11 I1 - - 0 io I DECK � o �rr /7r �rrrz.,z} 2� -wy-- -.-r7,,,,,•« ,u N v EXISTING 2 BEDROOM _,HOUSE z .zr.7. r -zz a ' #38 - t.-21 I ti .... _. .i).. ... M 1. _ l • 1^ I11;1��`i�j^ _`ISI✓ ASF'HAL I c.p. uPIVI•WAY f JUL 0 6 2022' ' LOT #378 12•000 Square Feet +;'- :, ,9y HEALTH DEPT. . i r 100.00' ;; '96, AO ( v�•1 I) 7'21- �. , _.. 40 _1- I_ .-. . 0 .T-% A- I-d C)_- I) ,r WA', `Ct,U 27fD-ti''I ..,,,---,0F .,-...