HomeMy WebLinkAbout2022 Sign off Transmittal - Replace and expand side entrance with deck „,-Y...1.,,,,,, TOWN OF YARMOUTH
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HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: 2 3J b L7/4 617/1.7
Proposed Improvement: A -A- 74- ---V./19•91.7-0 "s-/.P G— Ge—
flei W/ Scn1d 7WC1”'
Applicant: / -7Py Pet./j.--,1--__r- Tel. No.:b7 31-41 ?d (o)-e'
Address:S- -e- Date Filed: d 3— 7---2—
**Ifyou would like e-mail notification of sign off please provide e-mail address:
Owner Name: /1 2i2- V 74- ill&G/--C-- P4'"6-i-&-----/-1—_r-
Owner
Pa r ,i -
Owner Address: --6171'` Owner Tel. No.-sZ�-
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: 4DATE: v /2.
PLEASE NOTE
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