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HomeMy WebLinkAbout2022 Sign off Transmittal - Remove interior wall / Septic Compliance TOWN OF YARMOUTH HEALTH DEPARTMENT PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant. Building Site Location: 3 &.\✓✓S )640e-31- Proposed Improvement: o 6S1_ -�'rr ZQ 1® lbb ef,0 Ay aee O S�Cc v� c� 1`� I - Applicant: 11/14A-AnaLz 6c52,0uSSLA7 Tel. No.. Ob 3t,4 ci(, 1 Address: Pta441S1- A + +,ae�s c �. Cits,L08 Date Filed: 2I i IZ2- **/f you would like e-mail notification of sign off,please provide e-mail address: i4 4.4 CC2, C..ovl sT I C. w\. Owner Name: LCA. (Di Sob Owner Address: Owner Tel. No.: 2!'7 q3�7 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. RECEIVED Please submit three (3) copies of plans, to include: (1.) Site Plan showing existing buildings, water line location, and septic system location; HEALTH DEPT. (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. q REVIEWED BY: - i DATE: — a PL' ASE NOTE COMMENTS/CONDITIONS: T^ 3-4` f t Un 4". v Z O t70 r lw."w t 1 0 .A oXD V)a a rn _. . © II 0 0 NJ 0 N /j - f -4 /i ISJ I 1 1 I t fI I I ! 1 l It ) IVail- ! M 1 i 0 1 0 0 3 r (v 1 2 ]� 111 H ?" a rn C) 55 C) � � 1i s , =a 0 I --.4--.4... t r 1 4, b.-4416,...-ANQ -, ,,, R c I73 3 Q Ct. 0 0 i III. U 1-- H.ltf9 (0 g - , illrill 4. . / , . ..,,, 1 , p , , (71 C- 6 f , , , , , 4 a D 3 x0 4/9 rt. , I . , i .:.. _ - -IT _ ......... --N in 1-1.1A1 II r I Mr p 61111444710.1111 :Ial \ •....} ti iiWaiY IR3 l 2 0 xi o 1 2 3 2 !73ft 0 O , ti m i rrs - i ' ) x ---F4--. 1 i } i 44 V QleAdOM i � 03 111 0 ir rn I 11 0 , a mos g tz. mo D m I m CR d 2 A r7 M arr +�, 7 V no 3