HomeMy WebLinkAbout2022 Sign off Transmittal - Creating 3 Private Offices .�t_Y' r c TOWN OF YARMOUTH AUG 15 2022
.;7441. HEALTH DEPARTMENT
HEALTH DEPT"
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHE
To be completed by Applicant.
Building Site Location: 4S49" V' . t C- '4-f 6T (
Proposed Improvement: 1Ce a*i a' 4;e 59/44e.
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Applicant: CI: I �1 • D{.�/�'x Tel. No.:Li7-4In ''Ge
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Address: 'ft 4-kr Ail u i' /OM f 4960Date Filed:
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**/fyou would like e-mail notification of sign off,please provide e-mail addrestyVMV lar 441 qG 31nM1
Owner Name: SOtACC6 • •694
Owner Address: it106 [S Ry► S �sS/+tih�!"�I Owner Tel. No.:L I} 4-tel
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: 21----\/. DATE:
PLEASE NOTE
COMMENTS/CONDITIONS:
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