HomeMy WebLinkAbout2022 Sign off Transmittal - New Modular Home / 3 Bedroom Z..'
RECEIVED
1\• TOWN OF YARMOUTHA .'i� C' HEALTH DEPARTMENT
HEALTH DEP a-
PERMIT .APPLICATION SIGN OFF "TRANSMITTAL SHEET
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; To he completed hi Applicant
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Building Site Location: \—z.:1— G xtA--,C 9.S. �)e S'c `Ac,fr� k :
Proposed Improvement: IQ��J
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Applicant: J (h ` t `A i,,w .\LAddress: LA Z. UPJNc v �� QG �-,'\1•
Date Filed. ql 1/1-
"'!f you would like e-mail notification of-sign off please provide e-mail address " \
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Owner Name: S� ,, ` t,( 0,.-..
0\knerAddress: \ 1 C—x k-kf _t'(1 V \- Q -
Owner Tel No. J�1'1C-2- TSa`)°‘
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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:
roposed)—
Note: Floor plats not required for decks, sheds, windows, roofing;
(3.) If necessary, Title 5 application signed b\' licensed installer
with fee.
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REVIEWED FD BY
— I DATE. �— 2 — 'Z Z
COMMENTS/CONDITIONS: PLEASE NOTE
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